Literature Review

Negotiations end between Local 17 Nurses and Providence St. Patrick Hospital The Fairfield Sun Times - Missoula, MT, by Ian Alvano; 4/9/24 After a standstill of contract negotiations, a new contract has been ratified between the Local 17 Nurse Union and Providence St. Patrick Hospital. The nurses were looking for safe staffing ratios and competitive pay, in a new contract.  Some of the demands were met and some weren't, said Local 17 co-president, Kate Marmorato, regarding the new ratified contract between the nurses and the hospital. 

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 home-based healthcare could invite cyberattacks Modern Healthcare, by Diane Eastabrook; 3/29/24 Cybersecurity experts warn that as more healthcare is provided in patients’ homes, the flow of data between those locations, vendors and providers raises the risk for ransomware attacks. In the wake of the Change Healthcare attack, cybersecurity consultants are scrutinizing home-based care — particularly the storage and transfer of data through telehealth, remote patient monitoring and wearable devices. 

They work 80 hours a week for low pay. Now, California’s early-career doctors are joining unions Cal Matters, by Kristen Hwang; 4/8/24 ... In some California hospitals, early-career doctors make as little as $16 per hour working 80-hour weeks. It’s training, known as residency, that every board-certified doctor must complete. ... Last week, hundreds of resident physicians and fellows at Kaiser Permanente’s Northern California facilities became the latest to join the wave of medical trainees demanding better pay and working conditions. Their petition filed with the National Labor Relations Board comes after Kaiser Permanente refused to voluntarily recognize the union. 

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.

New hospice physician requirements sow claims submission confusionMcKnights Home Care, by Adam Healy; 4/8/24As hospice providers prepare for new physician certification rules going into effect next month, many are still seeking clarification from the Centers for Medicare & Medicaid Services on how the new rules will affect claims processes, experts said in a recent webinar. “The new requirement is effective May 1, 2024,” Katie Wehri, director of regulatory affairs for the National Association for Home Care & Hospice, said during the webinar Thursday. “We know that is right around the corner, and we have some concerns about that date, frankly, because of some of the inconsistent instructions that we have seen from CMS.”

How to talk about death Maine Public Radio, by Jennifer Rooks and Cindy Han; 4/5/24 Talking about death is not easy. We'll discuss why stigma and discomfort can impede end-of-life conversations, for the person who may be nearing death as well as for friends and family members. We'll find out how to address the emotional and spiritual aspects of dying. And we'll discuss the more practical legal, financial and medical matters to handle before and after someone has died.Panelists: Julie Weiss, social worker, Hospice of Southern Maine; Dr. Paul Segal, nephrologist, assistant professor of medicine; helped create curriculum for end-of-life doula students, University of New England; Dr. Fernando Moreno, palliative care specialist; medical director, Hospice of Southern Maine

Hospitals cash in on a private equity-backed trend: Concierge physician care KFF Health News, by Phil Galewitz; 4/1/24 Nonprofit hospitals created largely to serve the poor are adding concierge physician practices, charging patients annual membership fees of $2,000 or more for easier access to their doctors. It’s a trend that began decades ago with physician practices. Thousands of doctors have shifted to the concierge model, in which they can increase their income while decreasing their patient load. ...

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.

Optimizing RN responsibilities ‘more essential’ than staffing hours: study McKnights Long-Term Care News, by Josh Henreckson; 4/2/24 ... [New] analysis suggests that optimizing the role of registered nurses would be an even more effective way of increasing quality of care. Care quality would strongly benefit from an industry-wide focus on the responsibilities of RNs, the study’s authors said. Specifically, leaders should more actively differentiate RNs from licensed practical nurses, use a nursing practice model framework to maximize the role of RNs and provide RNs with more education in leadership and geriatric care.

Study shows strong social ties may ease the way for older adults in life's final chapter Medical & Life Sciences, by Vijay Kumar Maleus; 4/4/24  Study Results: ... The analysis revealed that higher levels of loneliness were significantly associated with increased odds of experiencing anxiety, sadness, and pain in the last month of life, suggesting a pivotal link between social isolation and end-of-life symptomatology. Furthermore, marital status and the receipt of personal care were predictors of dying in a hospital, pointing to the influence of social support structures on the location of death. Interestingly, a larger social network was correlated with a higher likelihood of receiving hospice or palliative care, highlighting the potential benefits of broader social connections. 

Qualitative analysis of initial palliative care consultations in amyotrophic lateral sclerosis Journal of Pain and Symptom Management; by Christine L Watt, Ian C Smith, Jill Rice, Rebekah Murphy, Ari Breiner, Maria Duff, Danica Nogo, Shirley H Bush, Susan McNeely, Usha Buenger, Belinda Zehrt, Jocelyn Zwicker; 4/2/24, online ahead of print Background: Palliative care (PC) benefits patients with amyotrophic lateral sclerosis (ALS), however the needs of patients and caregivers and the optimal timing of PC discussions remains unclear. This study reports the analysis of PC consult notes from a larger feasibility trial. The specific aims of this analysis were to i) identify the PC needs of patients with ALS via qualitative analysis and ii) identify characteristics of patients and caregivers that could predict specific PC needs.