Literature Review
All posts tagged with “Clinical News | Physician & Nursing News.”
AI scribes show promising results in helping family doctors and nurse practitioners spend more time with patients and less time on paperwork
09/13/24 at 03:00 AMAI scribes show promising results in helping family doctors and nurse practitioners spend more time with patients and less time on paperwork LaGrange Daily News, Toronto, Canada; by PR Newswire / Canada Newswire; 9/11/24 Family doctors report spending 70% to 90% less time on paperwork in a study evaluating the use of artificial intelligence (AI) scribe technology. OntarioMD (OMD), a subsidiary of the Ontario Medical Association (OMA), announced this week the findings of the study that examined the use of AI scribes by more than 150 family doctors and nurse practitioners (NPs) over a three-month period. AI scribes capture conversations between family doctors or nurse practitioners (NPs) and their patients and summarizes them into detailed electronic medical notes. The family doctors and NPs assessed AI scribes' effectiveness in reducing their time spent on administrative tasks and the results are very promising. ... The results also support the Ministry of Health and Ontario Health's Patients Before Paperwork (Pb4P) initiative aimed at helping doctors spend more time caring for patients instead of doing unnecessary paperwork.
Why so many patients are confused about CPR and do-not-resuscitate orders
09/12/24 at 03:00 AMWhy so many patients are confused about CPR and do-not-resuscitate orders STAT; by Lindsey Ulin; 9/11/24 Inherently difficult conversations are made more so by a lack of physician training. When a patient is admitted to the hospital in the U.S., there’s a standard question physicians like me are supposed to ask: “If your heart stops beating, do you want us to do CPR?” On the surface, this may seem like a mechanic asking a customer, “If your car stalls, do you want us to jumpstart the engine?” Who would say no to this, especially in a hospital? The problem is that this exchange, which we call asking about “code status” in medicine, centers around a closed-ended question. Talking to a patient about their preferences for cardiac resuscitation, intubation, and/or other life-sustaining treatments needs to be a complete, often lengthy discussion, not just a box to check. ...
On a culture of physician leadership development
09/11/24 at 03:00 AMOn a culture of physician leadership development Forbes; by Leon E. Moores, MD, DSc, FACS; 9/9/24 ... How do we create a culture of continuing physician leadership development? Over a decade ago, I was tasked with answering this very question. As a senior army surgeon, I approached the two-star general in the Army Medical Corps. I asked if I could put together a comprehensive program for physician leadership development for the 4200+ doctors in the US Army. ... We concluded that four distinct LOEs (lines of effort) needed development and implementation to create a culture of physician leadership. These LOEs, it turns out, are just as applicable in civilian healthcare as they were in the armed forces.
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.
Nursing students learning to respect culture, tradition at the end of life
09/10/24 at 03:00 AMNursing students learning to respect culture, tradition at the end of life St. Cloud Live, St. Joseph, MN; by Stephanie Dickrell; 9/6/24 It is called the golden hour — the hour before someone’s death. It’s a time of grief, but it’s also a sacred space. Two nursing instructors at the College of St. Benedict and St. John’s University are trying to make that time better for patients and their loved ones by better preparing their students who will be with them in their final moments. While the rituals surrounding death may vary by time, geography and culture, the program wants to make sure all cultures are respected. ... Julie Keller Dornbusch and Mary Pesch, both trained as Advanced Practice Registered Nurses ... received a prestigious grant from the Morgan Family Foundation of nearly $100,000 to create and test nursing simulations using culturally specific care for the Catholic community, Somali Muslims and Ojibwe people.Editor's note: This article indicates that "training material on culturally specific end-of-life care" is non-existent. This statement is misleading. Examine:
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."
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.
Majority of Mission nurses pledge support for strike vote
08/29/24 at 03:00 AMMajority of Mission nurses pledge support for strike vote The Biltmore Beacon, Asheville, NC; by Andrew R. Jones; 8/28/24 Nursing leaders at Asheville’s Mission Hospital said they have the pledges needed to call for a strike vote, increasing the likelihood of a significant labor action at the HCA Healthcare-owned facility if an agreement wasn’t reached this week. Local nursing representatives said that more than 800 of the approximately 1,600 registered nurses, including members of the Mission Hospital United union and non-union members, signed pledges agreeing to vote on a possible strike at the Asheville hospital, the only Level II trauma center in WNC. The vote will be held over four days, Aug. 25, 26, 28, and 29. Nurse union leaders told Asheville Watchdog that they anticipate most of the nurses covered by the union contract will authorize a strike that could last from one to three days. ... Several other unions at HCA hospitals across the nation — including those in Nevada, Florida, Texas and Kansas — are moving toward strike votes right now, nurses said. ...
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.
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.
Dr. Joe Rotella, AAHPM: The importance of being human – Reflections of an aspiring medical humanist
08/26/24 at 03:00 AMDr. Joe Rotella, AAHPM: The importance of being human – Reflections of an aspiring medical humanist American Academy of Hospice and Palliative Medicine; Event Details; retrieved from the internet 8/23/24The Importance of Being Human - Reflections of an Aspiring HumanistDate: September 17, 2024Time: 4:00 pm - 5:00 pm CTGrand Rounds free; Non-Members $49.00 USD
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.]
Hospice Insights Podcast - Stories of successful hospice leadership: The CEO and Chief Medical Officer relationship
08/23/24 at 03:00 AMHospice Insights Podcast - Stories of successful hospice leadership: The CEO and Chief Medical Officer relationship JD Supra; by Husch Blackwell; 8/21/24 A strong and engaged Chief Medical Officer (CMO) may be a hospice CEO’s most important asset. But what does a successful CEO/CMO relationship look like and how must it evolve to meet today’s challenges? In this episode we get to find out, as Husch Blackwell’s Meg Pekarske is joined by HopeHealth CEO Diana Franchitto and Dr. Edward Martin, CMO, whose trusted relationship has been instrumental to the organization’s success and clinical expansion.
West Penn Hospital union nurses vote to authorize strike
08/23/24 at 03:00 AMWest Penn Hospital union nurses vote to authorize strike WPXI.com news, Pittsburgh, PA; by Taylor Spirito; 8/22/24 Union nurses at West Penn Hospital have voted to authorize a strike. On Wednesday, union nurses votes 99.3% in favor of authorizing their negotiating committee to send a strike notice if necessary, rejecting contract proposals from the Allegheny Health Network (AHN) as inadequate to address the region’s nurse staffing crisis. The nurses are calling for resources to recruit new nurses and retain experienced ones. They said the hospital’s nursing staff must obtain 100 more registered nurses to meet the region’s growing patient care needs, a representative from SEIU Healthcare PA said.
Bioethicists scrutinize Pontifical Academy for Life’s new guidance on withdrawing food, water
08/21/24 at 03:00 AMBioethicists scrutinize Pontifical Academy for Life’s new guidance on withdrawing food, water The Catholic World Report; by Jonah McKeown; 8/16/24 After the Pontifical Academy for Life (PAFL) last month issued a booklet summarizing the Church’s teaching on a number of bioethical issues, the section on “artificial nutrition and hydration” (ANH) has some observers concerned about what they see as a departure from previous Church teaching. ... The Church’s teaching on this issue was recently in the news in the United States because of the ongoing case of Margo Naranjo, a disabled Texas woman whose parents, who are Catholic, announced last month that they had decided to allow Margo to die by starvation in hospice. They were prevented from doing so after a judge intervened. ... What does the Pontifical Academy's new document say? ... “[T]he doctor is required to respect the will of the patient who refuses them with a conscious and informed decision, also expressed in advance in anticipation of the possible loss of the ability to express himself and choose,” the PAFL wrote. he PAFL noted that Pope Francis has emphasized the importance of considering the whole person, not just individual bodily functions, when making medical decisions.Editor's Note: This "guidance" and discussion is much more complex than the summarized information above. Click on the title's link to read more.
Hospice physician’s convictions and $15 million in restitution affirmed for ‘pervasive’ fraud
08/21/24 at 02:00 AMHospice physician’s convictions and $15 million in restitution affirmed for ‘pervasive’ fraud CCH Incorporated; by Justin Marcus Smith, J.D.; 8/15/24 The Fifth Circuit found it circumstantially telling that the jurors saw multiple hospice patients testifying at trial nearly a decade after the convicted physician had recommended them for end of life care. In an unpublished opinion, the United States Court of Appeals for the Fifth Circuit affirmed a physician’s conviction for conspiracy to commit health care fraud and for seven individual counts of healthcare fraud in connection with hospice care service recommendations. Applying de novo review, the court affirmed the convictions on the basis that the government presented enough circumstantial evidence, without direct evidence of intent, for a reasonable jury to have found guilt. With respect to sentencing, the circumstances surrounding 7,000 hospice claims formed a basis for fraud so pervasive that the government did not need to “sift” through each of the claims.
Medical marijuana study details Arkansans’ use of the drug, raises questions from lawmakers
08/20/24 at 03:00 AMMedical marijuana study details Arkansans’ use of the drug, raises questions from lawmakers Arkansas Times; by Tess Vrbin for the Arkansas Advocate; 8/15/24 ... The study, conducted by the Arkansas Center for Health Improvement, is the first ever population-based study of medical marijuana funded by a federal health agency, the National Institutes of Health. ... The state currently has more than 105,000 cardholders, an increase of roughly 29,000 in three years, according to ACHI’s study. ... Lawmakers on the Joint Public Health, Welfare and Labor Committee ... expressed concerns about some of the information in the study, such as the fact that one-third of the certifications for medical marijuana cards in 2021 came from just seven doctors, with little evidence of a physician-patient relationship in many cases.Thirty-eight states and the District of Columbia have legalized marijuana to some extent, and Arkansas is one of 14 states in which the drug is legal only for medicinal purposes.
4 ways health systems combat burnout
08/19/24 at 03:00 AM4 ways health systems combat burnout Becker's Hospital Review; by Kristin Kuchno; 8/13/24 Although burnout is down among healthcare professionals, its persistence still garners attention and solutions from systems. Physician burnout fell from 53% in 2022 to 48.2% in 2023, according to a July 2024 report by the American Medical Association. ... Here are four methods four hospitals and health systems are using to address workforce burnout.
Dr. Oswalt on the effects of palliative care timing on end-of-life care in mNSCLC
08/19/24 at 03:00 AMDr. Oswalt on the effects of palliative care timing on end-of-life care in mNSCLC OncLive, Oncology Specialty Group; by Cameron James Oswalt, MD; 8/15/24 Cameron James Oswalt MD, fellow, Hematology-Oncology, assistant professor, medicine, Department of Medicine, Duke University School of Medicine, discusses findings from a study evaluating the timing of palliative care referral and its effect on end-of-life care outcomes in patients with metastatic non–small cell lung cancer (mNSCLC). ... Investigators found that fewer than half of patients received palliative care during their treatment course, and fewer than one-third of the patients who received palliative care accessed this care within 2 months of diagnosis, ... The low referral rate in this cohort could be attributed to several factors, including patient preferences, preconceived notions, barriers to referral, and overall disease burden, he says. Among patients who died, 59.1% were enrolled in hospice.
Person-centered, goal-oriented care helped my patients improve their quality of life
08/16/24 at 02:15 AMPerson-centered, goal-oriented care helped my patients improve their quality of life Journal of the American Board of Family Medicine; by Lee A. Jennings and James W. Mold; orignially posted 5/24 issue, again on 8/15/24 When the goal is to help patients improve their quality of life, it makes sense to focus directly on the activities and relationships that are most important to each patient. This can be accomplished most effectively by following a three-step process that includes 1) connecting with the patient around what matters to them, 2) co-creating a goal-oriented plan, and 3) collaborating with patient, family, team members, and consultants to increase the probability of success. Once this approach has been mastered and the necessary systems, processes, and relationships are in place, this should not take more time than a problem-oriented approach, and it will almost certainly be more satisfying for both physician and patient. Editor's Note: Simple. Effective. Meaningful.
Hospice and Palliative Nurses Foundation receives $1.2 million impact grant
08/16/24 at 02:00 AMHospice and Palliative Nurses Foundation receives $1.2 million impact grant Hospice & Palliative Nurses Association (HPNA); August 2024 newsletter, with webpage posted 7/8/24 The Hospice and Palliative Nurses Foundation (HPNF) is thrilled to announce that it has been awarded a transformative $1.2 million impact grant from the Hospice and Palliative Credentialing Center (HPCC). The Sandra Lee Schafer Impact Grant, given in memory of the late Sandra Lee Schafer, MN, RN, AOCN®, will empower HPNF to create a legacy of sustainable giving, which will impact the hospice and palliative care community for years to come. “We are deeply honored and grateful to receive this impact grant from HPCC, given in tribute of Sandy,” said Virginia (Ginger) Marshall, MSN, ACNP-BC, ACHPN®, FPCN, chief executive officer of HPNF. Sandra was an unwavering advocate of specialty nursing certification. ... Sandra served as the director of credentialing of the Hospice and Palliative Credentialing Center from 2004 until her sudden passing in 2018.
Death is inevitable. It's time we learned to talk about it.
08/15/24 at 03:00 AMDeath is inevitable. It's time we learned to talk about it. MedPageToday; by Nidhi Bhaskar; 8/13/24 By fostering honest and compassionate discussions, we can provide patients with more dignity. Years ago, in a busy emergency department, I found myself joining my mentor at the bedside of an elderly man experiencing chest pain. After completing the physical exam, the doctor unceremoniously changed gears to abruptly ask our patient, "If your heart were to stop beating, do you want us to do everything?" Between the stress of the situation and the vague and awkward delivery of the question, our patient seemed (understandably) overwhelmed. So was I. ... End-of-life conversations can feel like a "word soup" of sorts ... it is easy for patients and providers alike to feel lost. ... Providers must also consider the nuances of cultural attitudes towards death; the location and family arrangements surrounding a person at the end of life; and the varying emotional responses and feelings of decision paralysis surrounding how one dies and how one feels about dying.Editor's Note: For a related article in our newsletter today, read "Examining the relationship between rural and urban clinicians’ familiarity with patients and families and their comfort with palliative and end-of-life care communication."