Literature Review
All posts tagged with “Clinical News.”
When rounding sparked improvements, per 4 chief nursing officers
09/10/24 at 03:00 AMWhen rounding sparked improvements, per 4 chief nursing officers Becker's Hospital Review; by Erica Carbajal; 9/5/24 Rounding the floor with front-line nurses and staff is more than just a management practice for leaders to show face — it is a vital tool for connecting with employees and driving meaningful change. In conversations with hospital leaders, they often echo the sentiment of how routinely spending time with front-line staff uncovers opportunities to address pain points in their daily workflow. With nurses often pointing to lack of resources and support as drivers of job dissatisfaction and burnout, rounding represents a key strategy to positively affect staff engagement and retention, and thus, patient care. Becker's recently asked four chief nursing officers to share a recent example of a time when rounding sparked a process change or improvement at their hospital. Here are their responses: ... Editor's note: "Rounding" best practices and outcomes apply to hospice and palliative care multidisciplinary teams.
Bittersweet bouquet: Hospice worker transforms her grief into a garden of memories
09/09/24 at 03:00 AMBittersweet bouquet: Hospice worker transforms her grief into a garden of memories ABC 13, Grand Rapids, MI; by Matt Gard; 9/5/24For the most part, Kaitlyn Dawson’s desk at the Emmanuel Hospice office is exactly what you’d expect it to be. On her left, she has office supplies, ... but it’s what’s on the wall over her left shoulder that really gives this workspace character. Inside three separate picture frames are hundreds of flowers. Kaitlyn was an art major at Grand Valley State University before she switched to social work, and she still has a passion for creativity. Every one of those flowers – whether red, purple or orange - was her creation. ... “These flowers represent patients that I have been able to be a part of their journey at end of life,” said Kaitlyn, who has worked in hospice for about four years. “I had one particular case that was really difficult, and I remember leaving that visit and thinking ‘I'm going to start doing this process in honor of her.’ And I went to the store and I bought pencils and a notebook and decided I was going to do flowers. It was easy. It was simple. It was something I could sit down and do in the evening, and if I lost a couple of people that day, I could draw a couple of flowers.” Before Kaitlyn knew it, she had a "bittersweet bouquet."
Hugo man dies in house fire [hospice patient]
09/09/24 at 03:00 AMHugo man dies in house fire [hospice patient] KXII 12 TV, Hugo, OK; by KXII Staff; 9/5/24 A fire at a home in Hugo claims the life of a former Choctaw County assistant district attorney. Officials said the fire happened Sunday afternoon. The Choctaw County Emergency Manager told News 12 that John Bounds, who was in hospice care, was unable to escape. All others in the house got out safely.Editor's note: What emergency discussions do your interdisciplinary team members have with home hospice patients and their caregivers? Regular fire safety training (and other forms of patient care safety, workplace safety, etc.) are required by OSHA and accreditation organizations.
American Heart Association affirms importance of palliative care in treating cardiac conditions
09/06/24 at 03:00 AMAmerican Heart Association affirms importance of palliative care in treating cardiac conditions Hospice News; by Jim Parker; 9/4/24 Multidisciplinary palliative care offers clear benefits to patients with cardiovascular disease, particularly when it comes to medication management and goals-of-care conversations. Palliative care with effective medication management, shared decision making and symptom management can help improve quality of life for heart disease patients, according to a scientific statement from the American Heart Association (AHA) — “Palliative Pharmacotherapy for Cardiovascular Disease.” The statement offers guidance for health care providers to integrate palliative methods as part of holistic medication management at all stages of a patient’s illness, the AHA indicated. This underscores the importance of collaboration between palliative care professionals and other clinical specialties, according to Dr. Andrew Esch, director of palliative care program development at the Center to Advance Palliative Care (CAPC).
Allowing patients to die: Louise Aronson and Bill Andereck
09/06/24 at 03:00 AMAllowing patients to die: Louise Aronson and Bill AndereckGeriPal podcast; by Alex Smith, Eric Widera, Louise Aronson, Bill Andereck; 9/5/24In today’s podcast we set the stage with the story of Dax Cowart, who in 1973 was a 25 year old man horribly burned in a freak accident. Two thirds of his body was burned, most of his fingers were amputated, and he lost vision in both eyes. During his 14 month recovery Dax repeatedly demanded that he be allowed to die. The requests were ignored. After, he said he was both glad to be alive, and that the doctors should have respected his wish to be allowed to die. But that was 1973, you might say. We don’t have such issues today, do we? Louise Aronson’s recent perspective about her mother in the NEJM, titled, “Beyond Code Status” suggests no, we still struggle with this issue. And Bill Andereck is still haunted by the decision he made to have the police break down the door to rescue his patient who attempted suicide in the 1980s, as detailed in this essay in the Cambridge Quarterly of HealthCare Ethics.
Beers Criteria update for medication use in older adults
09/05/24 at 03:00 AMBeers Criteria update for medication use in older adultsMedscape Nurses; by Linda Girgis; 8/30/24Primary care physicians know the complexities of treating older patients, from increased complications from medications and procedures to comorbidities stemming from having multiple medical conditions. The Beers Criteria were established by the American Geriatrics Society as a guide for physicians about medications that may possess more risks than benefits in older patients, specifically those aged 65 years and older. There are approximately 100 medications on the list. Criteria used to establish the list include medications to avoid over the age of 65 in an outpatient setting, medications to avoid in certain medical conditions, medications to avoid that may interact with other medications, medications to avoid with renal impairment, and medications to avoid where harmful side effects outweigh the possible benefits. The American Geriatrics Society updates the list as new published evidence becomes available.
“Rehabbed to Death” in oncology: Where do we go from here?
09/05/24 at 03:00 AM“Rehabbed to Death” in oncology: Where do we go from here?JCO Oncology Practice; by Daniel E. Lage, Craig D. Blinderman, Corita R. Grudzen; 9/3/24You can go to rehab to see if you get stronger for chemo. These are words that every clinician caring for hospitalized patients with cancer has heard or said countless times. And yet, especially when it comes to older adults with advanced solid tumors, less than a third of these patients will ever receive systemic therapy again. Furthermore, their symptom profile is more similar to those discharged to hospice than to those discharged home, and they face debilitating functional decline and early mortality—leading some to coin the term “rehabbed to death” to describe this phenomenon. We suggest a few keys area of focus: (1) reframing hospital discharge conversations, including incorporating practices of disclosing prognoses using validated tools or other algorithms; (2) empowering team-based care and inclusion of palliative care clinicians in the SNF setting; and (3) identifying patients failing to make functional progress early. [Also see accompanying article: Respect for the Patient-Oncologist Relationship May Limit Serious Illness Communication by Acute and Postacute Care Clinicians After Discharge to a Skilled Nursing Facility by Sarguni Singh, Ashley Dafoe, John Cagle, Elizabeth R. Kessler, Hillary D. Lum, Brooke Dorsey Holliman, Stacy Fischer.]
Interventions provided by palliative care social workers: Provide interventions that lessen suffering in patients living with serious illness
09/05/24 at 03:00 AMInterventions provided by palliative care social workers: Provide interventions that lessen suffering in patients living with serious illnessUniversity of Colorado Anschutz Medical Center email; by Melissa C Palmer; 9/3/24... Reflecting on my own years of experience as a palliative care social worker, the work we do is not as clear-cut as being able to prescribe medication for a symptom or titrate pain medication. The art of the intervention for social work takes time, patience, and congruent presence. To the layperson, it may appear that our interventions are just to talk with people. But that is just a small piece of the beauty and grace that evolves from our work.
Doctors use problematic race-based algorithms to guide care every day. Why are they so hard to change?
09/04/24 at 03:00 AMDoctors use problematic race-based algorithms to guide care every day. Why are they so hard to change?Stat email and article; by Katie Palmer, Usha Lee McFarling; 9/3/24Doctors use clinical algorithms every day to make decisions about the care they provide to patients. This math determines things like our surgical risk or likelihood of disease using factors such as blood pressure, age, weight, surgical history, and, often, our race. But one of these is not quite like the others — for years, clinicians have pushed back against the use of race in clinical algorithms. Publisher's note: Interesting article, although accessing full article may require subscription.
Why one health system thinks its new PBM can disrupt the market
09/04/24 at 03:00 AMWhy one health system thinks its new PBM can disrupt the marketModern Healthcare; by Lauren Berryman; 8/23/24The University of North Carolina-affiliated health system announced a plan this month to launch UNC Health Pharmacy Solutions, a "transparent" PBM for employers seeking an alternative to CVS Health subsidiary CVS Caremark, Cigna division Express Scripts and UnitedHealth Group unit OptumRx, which dominate the market... “Our costs were skyrocketing,” DeFalco said. UNC Health has since in-sourced key PBM functions and customized its formulary to focus on lower net cost drugs. UNC Health Pharmacy Solutions is similar to others that market themselves as transparent. UNC Health will charge clients administrative fees and pass through all rebates to plan sponsors. The health system has saved 32% on employee pharmacy costs and expects to deliver similar results to employers in North Carolina and South Carolina, DeFalco said. The health system may consider partnering with businesses in bordering states down the line, she said... The landscape comprises around 70 players, but CVS Caremark, Express Scripts and OptumRx have a combined market share of about 80%, and the top six PBMs control 90%. Larger PBMs generally can use scale to extract better rebates from drugmakers, which at face value could look attractive to benefits brokers even though it may not mean lower overall savings.
Hoffmann Hospice to host Grief Support Camp for Children of first responders
09/03/24 at 03:00 AMHoffmann Hospice to host Grief Support Camp for Children of first responders KGET Bakersfield, California; by Jaspreet Multani; 8/29/24 Hoffmann Hospice will host its second annual free grief support camp for children and teens of first responders on Saturday, Sept 14, 2024. The event called “A Heart for Hero’s Art Camp,” provides a safe space for young people grieving the loss of a loved one such as a parent, sibling, or grandparent. ... Led by experienced grief counselors, the camp offers therapeutic activities and support to help children express their grief in a nurturing environment. ... “We have a huge heart for kids, especially those who put themselves on the line for us every day,” said Ryan D’ Amato of Hoffmann Hospice.Editor's Note: While many hospices provide excellent grief camps for children and teens, this one stands out for tending the unique experiences for families of first responders. Many of these deaths will have been sudden and tragic--without hospice care--and often more complex to grasp and grieve. Hoffman Hospice's website indicates support for other non-hospice deaths: Miscarriage, Still Birth or Sudden Loss; Suicide. Bravo and thank you to Hoffman Hospice and other hospices who utilize your grief services to support your larger communities through often-disenfranchised deaths and grief.
Loneliness tied to death ideation in older adults, study finds
09/03/24 at 03:00 AMLoneliness tied to death ideation in older adults, study findsMcKnight's Long-Term Care News; by Kristen Fischer; 8/29/24A new study explored the relationship between loneliness, suicidal thoughts and death ideation in older adults. Overall, feeling lonely was linked with thoughts of wanting to die, according to the results... The researchers found that the subjective feeling of loneliness was more strongly linked with death ideation than with other measures of social disconnection, such as living alone or being socially isolated. The association between loneliness and a wish to die remained strong after the team controlled for depression and other markers of social disconnection. Regular attendance at religious services and other communal activities helped lower death ideation among the adults. Cognitive-behavioral therapy targeting depression and anxiety may also reduce the impact of loneliness.Publisher's note: It is difficult to underestimate the impact of loneliness and social disconnection. This article and study provide interesting implications for hospice patients and those who love them.
Grief Memoir: ‘It was my turn to do everything for her’
08/30/24 at 03:00 AMGrief Memoir: ‘It was my turn to do everything for her We Are The Mighty; by Jessica Hall; 8/28/24 ... I joined the phone call with the doctor where he told us all the worst news. The cancer was growing everywhere along the spine. ... He told us that it was time for hospice. ... Even though I had been preparing for this for months, I was truly not ready to go from child to caretaker. ... For my entire life, my mom had cared for me. She had been there when I was sick or hurt. She cleaned my house (sometimes to my chagrin). She cooked my favorite meals and she let me take breaks. Now it was my turn to do everything for her. It hit me like a ton of bricks, but I also just knew that I had to do it. We all had to do everything for her to make her final days easy for her. Hospice came by to get everything set up. ... [Click on the title's link to continue reading this beautiful, personal story.]Editor's Note: Calling all hospice executive leaders who do not have clinical, direct patient care experience--read this article to grasp common family dynamics, decisions, actions, emotions, and life-changing moments for each patient you serve. Multiply this out for the many family members of each patient you serve. How do your hospice services tune into and support these family members?
This was the year advanced practice nurses thought they’d get full practice authority in NC. They were wrong.
08/30/24 at 03:00 AMThis was the year advanced practice nurses thought they’d get full practice authority in NC. They were wrong.NC Health News - NC Board of Nursing; by TwumasiD-Mensah; 8/29/24 Every so often, Megan Conner, a nurse anesthetist in Greenville said she sees a patient who’s driven for hours to come for a screening colonoscopy but who instead has to be sent to the emergency department. ... It frustrates Conner that so many patients, who have to travel sometimes hours for care in eastern North Carolina, end up not getting it because of common ailments they can’t get treated closer to home.That’s why Conner is a big believer in the Safe, Accessible, Value-directed and Excellent Health Care Act (SAVE Act), which would give advanced practice registered nurses (APRNs) like her full practice authority. She argues the data show that more nurse practitioners would provide primary care in rural North Carolina if the state would give them autonomy to practice, bringing care to small burgs that often go without. And now, the demands for care are being driven by hundreds of thousands of patients newly eligible for care because of Medicaid expansion. Along with a growing number of lawmakers who believe the legislation is overdue, advanced practice nurses thought this would be the year that the SAVE Act finally passed. They were wrong. [Click on the title's link to continue reading.]
Rounds with Leadership: Focusing on the outcomes of NP practice
08/30/24 at 03:00 AMRounds with Leadership: Focusing on the outcomes of NP practice American Association of Colleges of Nursing - The Voice of Academic Nursing; by American Colleges of Nursing (AACN); 8/28/24 ... In a synopsis of more than 50 research studies, the American Association of Nurse Practitioners found that patients under the care of NPs have fewer unnecessary hospital readmissions, higher patient satisfaction scores, and fewer unnecessary emergency room visits than patients under the care of physicians only. Recent studies have shown that ... NPs engaging in end-of-life care had fewer hospitalizations and higher hospice use; ... Despite such compelling evidence, challenges to NP education and practice continue. More than 20 states have yet to grant full scope of practice authority to NPs, denying these expert clinicians the opportunity to exercise the full range of their clinical expertise.
Not intervening as a form of care: Negotiating medical practices at the end-of-life
08/29/24 at 03:00 AMNot intervening as a form of care: Negotiating medical practices at the end-of-life AnthroSource, by the American Anthropological Association; by Simon Cohn, Eric Borgstrom, and Annelieke Driessen; 8/27/24 ... The story of Keith, a patient living with multiple sclerosis but now with limited time left, introduces a common feature of biomedicine; once set on a particular trajectory, clinicians are often committed to a cascade of options without really questioning their ultimate value: "When I saw the doctor, the first thing he said was, ‘Oh, we can do this, or we can do that…’ So I said, ‘No, you won't. You won't do any of those things, thank you very much.’ And then when he suggested a drug that will give me ‘an extra few months’, I replied ‘Does that give me an extra few months now, or an extra few months at the end? Because I want the few months now, I don't want them at the end.’" Here, Keith recounts how his doctor seemed compelled to suggest one treatment after another with the intention of prolonging his life, rather than acknowledge that because he was dying, a different approach might be more appropriate. ...
Doctors saved her life. She didn’t want them to.
08/27/24 at 03:00 AMDoctors saved her life. She didn’t want them to. DNYUZ; by Kate Raphael; 8/26/24 Marie Cooper led her life according to her Christian faith. ... [And, she] always said that at the end of her life, she did not want to be resuscitated. ... Last winter, doctors found cancer cells in her stomach. She’d had “do not resuscitate” and “do not intubate” orders on file for decades and had just filled out new copies, instructing medical staff to withhold measures to restart her heart if it stopped, and to never give her a breathing tube. In February, Ms. Cooper walked into the hospital for a routine stomach scope to determine the severity of the cancer. After the procedure, [Ms. Cooper's daughter] visited her mother in the recovery room and saw her in a panic. ... [The daughter] called for help and was ushered to a waiting room while the medical team called an emergency code. Ms. Cooper grew even more distressed and “uncooperative,” according to medical records. Doctors restrained her and inserted a breathing tube down her throat, violating the wishes outlined in her medical chart. Ms. Uphold, livid, confronted the doctors, who could not explain why Ms. Cooper had been intubated. ...
My dad had an Advance Directive. He still had to fight to die
08/27/24 at 03:00 AMMy Dad had an Advance Directive. He still had to fight to die Newsweek - My Turn; by Maggie Schneider Huston; 8/26/24 My mom died peacefully. My dad died 72 days later, angry at the doctors for ignoring his wishes. ... Dad had heart surgery on December 20, 2023. An hour after the surgery ended, his vital systems started shutting down. A cascade of interventions, one after another, kept him alive. Four days later, he said: "Put me on hospice." The doctor dismissed this request, rolling his eyes and saying: "Everyone on a ventilator says that." On Christmas Day, my father asked for hospice again. He was in pain. He knew his recovery would be long and ultimately futile. He would never have an acceptable quality of life again. ... Dad's care team insisted palliative care was the same as hospice care, but he knew the difference. He wanted hospice care. Finally, they reluctantly agreed and called for a social worker to make arrangements. It wasn't necessary. Once they removed his treatment and relieved his pain, he died five hours later. ... Editor's Note: This article is not about Medical Aid in Dying (MAiD). It is about honoring Advance Directives, person-centered care with communications and actions related to "palliative" vs. "hospice" care.
Hospice student volunteers gain insight into dementia
08/27/24 at 03:00 AMHospice student volunteers gain insight into dementia Ahwatukee Foothills News; by Lin Sue Flood; 8/23/24 Once a week, graduate nursing student Merle Tamondong pauses her busy college life to visit Micheline Schulte. They color together, play Micheline’s favorite songs and chat in French, her native language. “When I come here, the only time I’m on my phone is when I’m playing some music, which Micheline likes when we are coloring,” Merle said. “I feel very lucky.” Merle is part of Hospice of the Valley’s College Partners Program, an innovative collaboration with Maricopa Community Colleges, Arizona State University and other schools to provide socialization to people living with dementia and a much-needed break to family caregivers. Hospice of the Valley’s dementia and volunteer departments spearheaded this intergenerational program to help inspire careers in dementia care. ... To date, 106 students have been trained and paired with 123 patients since College Partners launched in 2021 with a grant from Community Care Corps.
Avoid these mistakes in palliative care to enhance your loved one's well-being
08/27/24 at 02:00 AMAvoid these mistakes in palliative care to enhance your loved one's well-being Leesville Leader, Lake Charles, LA; by Evertise Digital; 8/26/24 For people with life-threatening diseases, palliative care is crucial in providing comfort and improving quality of life. It’s essential to focus on the details and avoid common mistakes in order to deliver good treatment. Mistakes in palliative care can inadvertently cause discomfort or diminish the quality of the support provided. It’s critical to recognize and steer clear of certain mistakes to guarantee that your loved one receives the finest treatment possible. By focusing on these key areas, you can enhance their well-being and provide the compassionate, attentive care they need during this challenging time.
“What I wish I knew about dementia”: A caregiving only child’s experience
08/23/24 at 03:00 AM“What I wish I knew about dementia”: A caregiving only child’s experience The Healthy; by Dr. Patricia Varacallo, DO; 8/20/24 It's no secret dementia affects the brain of the patient, and tests the hearts of their loved ones. Through one woman's personal journey, experts advise on the emotional, medical, and financial aspects of caregiving for dementia. ... Drawing from Ann’s caregiving journey and insights from Dr. Wint and Lucille Carriere, PhD, Cleveland Clinic Angie Ruvo Endowed Caregiving Chair, we share their collective wisdom on what they wish more people knew about dementia.
How to recognise the dying phase in palliative and end-of-life care
08/23/24 at 03:00 AMHow to recognise the dying phase in palliative and end-of-life care Nursing Times; by Julie Kinley and Cathriona Sullivan; 8/19/24This article gives practical guidance for nurses on providing care in the last days of life. ... Birth and death are two certainties in life. Consequently, during their career, many nurses will support, and indeed lead, the management of the care of dying people. ... [Knowing] how to recognise – and manage – this phase of life remains a career-long key responsibility and role. ... In any setting, nurses are part of a wider team. The recognition of dying and the dying phase can be enhanced if everyone:
The importance of competencies in pain management and palliative care
08/23/24 at 03:00 AMThe importance of competencies in pain management and palliative care Greenwich Sentinel, Greenwich, CT; by Russell R. Barksdale, Jr.; 8/21/24 ... Competencies, ongoing pharmacological education, regular patient pain assessments, management, and medication adjustments are all crucial processes for healthcare providers in today’s complex medical environment. Regrettably, metabolic and behavioral issues related to pain medications, especially opioids, if not properly managed, poses risk of addiction. Beginning in the late 1990s, the consumption of medical opioids used to treat pain increased in many countries worldwide. Since that time, alarmingly the United States has outpaced every other country in per capita opioid consumption. ... [Click on the title's link to continue reading.]
Virtual reality tech takes hospice patients to faraway places
08/21/24 at 03:00 AMVirtual reality tech takes hospice patients to faraway places Yuma Sun; by Alex Ebrahimi; 8/18/24 Hospice patients take trips to those faraway places they never got to visit or simply see the faces of family again no matter where in the world they are. These "trips" are made possible with the use of free virtual reality headsets offered by Southwestern Palliative Care and Hospice. The first patient to wear the VR headset had worked all his life out in San Diego as a crane operator. The paychecks didn't go beyond the roof over his family's head. Now he's able to see some of the places he never got to see in real life.Editor's Note: To read more examples, click on the title's link.
Integration of palliative pharmacists to elevate oncologic care
08/21/24 at 03:00 AMIntegration of palliative pharmacists to elevate oncologic care Pharmacy Times; by Alexis Beachy, PharmD and Jessica Geiger, PharmD, MS, BCPS; 8/20/24... Conclusion: This case demonstrates several aspects of care palliative pharmacists can assist with, though it is certainly not all-encompassing. All things considered, pharmacists are an essential asset of the palliative team. Their experience further enriches the interdisciplinary team and grants all patients and families many benefits. Specifically, patients receiving oncologic care benefit from collaboration with a palliative care pharmacist. In addition to offering a more individualized and holistic approach to care, palliative pharmacists can also provide patients with quicker and improved symptom management, which often improves quality of life and may also increase survival rates.Editor's Note: This article provides excellent history, definitions, and descriptions of the pharmacist's significant role in providing expert palliative and hospice care.