Literature Review

‘We did it!’: West Penn nurses celebrate their new contract Pittsburgh Union Press, Pittsburgh, PA; by Steve Mellon; 9/12/24 Before Joanne Germanos had a chance to approach a podium to make her announcement, someone in the crowd called out, “We did it!” ... What Germanos and her fellow union nurses at West Penn did was win a new contract that raises pay and addresses staffing and burnout issues that the nurses say have been pushing experienced nurses out of the profession. Ninety percent of the hospital’s union nurses voted to approve the contract Wednesday. Under the three-year deal, pay for nurses will rise an average of 24%, with some seeing increases as high as 35%. By contract’s end, all nurses will make at least $40 an hour; nurses with 20 years of experience will make at least $50 an hour. ... Pay, however, isn’t the only issue. At rallies, union nurses have called on hospital administrators to address staffing and scheduling problems that can affect patient care and cause nurse burnout. They took those concerns to the bargaining table and, on Thursday, said they were thrilled with the outcome.

Innovative program reduces nurse turnover and fosters development Oncology Nursing News; by Heather Wood, RN, OCN and Marie Garcia, RN, OCN; 9/12/24 Cancer incidence is on the rise in the US, especially among the growing older population. ... Unfortunately, the current shortage of oncology nurses is expected to worsen, as fewer people enter the profession while aging nurses retire. By 2025, a shortage of 200,000 to 450,000 oncology nurses is predicted in the US. ... In response, The US Oncology Network (The Network) has developed one of the most comprehensive programs in the nation to support the professional development and retention of new oncology nurses. ... Designed to enhance their knowledge of fundamental oncology, OCEAN is a collaborative effort bringing together a multidisciplinary team of experts and speakers from across The Network. The program provides fundamental oncology knowledge around 12 core areas delivered over 22.5 hours of live virtual learning. Content ranges from ... various treatment modalities ... to palliative care and advanced care planning. OCEAN’s impact extends beyond skill development, fostering a sense of belonging and purpose among participating nurses. ... Early results from the program are promising, such as increased retention rates [12% better than the national average] and cost savings. 

Why 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. ...

Nursing 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 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."

Rounds 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 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. ...

My 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.

Dr. 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

West 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 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.

Medical 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.