Literature Review

Supporting the Sandwich Generation: Taking care of the caregiver The Examiner News, Mount Kisco, NY; by Mary K. Spengler; 6/25/24 Many Westchester residents struggle to find a balance between work and home responsibilities. Those who fall in the “sandwich generation,” typically qualified as those in their 30s or 40s, can find themselves with the unique role of bringing up their dependent children while also caring for their aging parents, all while juggling their careers. Multigenerational needs became even more pressing during the pandemic, with record numbers of adult children moving back home, younger children having to switch to virtual or hybrid learning and elderly parents needing new forms of care. Sandwich generation caregivers provide an important source of support and love to family members, and often experience feelings of satisfaction and meaning in their lives from being in this role. However, many also feel highly strained and overwhelmed due to the emotional, physical and financial burden weighing on them. Implementing positive strategies to better care for themselves while they care for others is imperative to combating caregiver burnout. ... Editor's Note: Mary K. Spengler is a registered nurse and social worker and serves as CEO of Hospice of Westchester.

171K+ clicks saved: Inside Johns Hopkins' nurse documentation revamp Becker's Clinical Leadership; by Erica Carbajal; 6/17/24 Across healthcare, efforts to advance documentation are often focused on enhancing physicians' workflow. But at Baltimore-based Johns Hopkins Hospital, leaders are equally focused on improving documentation in nursing. ... [The] American Nurses Credentialing Center recognized Johns Hopkins with 10 exemplars, one of which recognized the hospital as a leader in nursing informatics. Case in point: The hospital has saved nurses 170,620 clicks in four months, April Saathoff, DNP, RN, vice president and chief nursing information officer at Johns Hopkins Medicine, told Becker's. ... "Instead of the nurse having to go in and document on every single row on a head-to-toe reassessment for the patient, we now have some fields added to the top where the nurse can document reassessment changes noted or reassessed no changes," Dr. Saathoff said, adding that the changes are saving nurses an average of 13 minutes per reassessment. Editor's Note: What might your organization be able to streamline in your online documentation? Before IT or clinical management decides unilaterally, get input from your clinicians who make the visits and use the system. Include your psychosocial/spiritual care team members as well, as you might delete something crucial that they need.

Psychological health in Palliative Care: Thematic analysis of a psychiatrist's and an art therapist's clinical reflexive journals Palliative Medicine; by Wen Phei Lim, Roxanne Jia Yu Chew, Clare O'Callaghan; 6/19/24 online ahead of print Aim: This study aims to describe how patients receiving palliative care experience psychological health, explore the meaning of a palliative care clinician's work and contribute to the understanding of psychological health in palliative care through the reflexive and visual journals of clinicians.

AFT launches new union physicians’ organizing effort: Doctors across the country are joining together for rights and respect American Federation of Teachers; by Alexis Lopez; 6/18/24  AFT President Randi Weingarten announced the launch of a brand-new doctors’ organizing initiative and division: Union Physicians of AFT. Doctors across the country are faced with crippling burnout from administrative overload, frustration over financial barriers affecting their patients’ capacity to pay, and lack of respect from corporate owners who put profits over patients—and now they’re organizing with the AFT to fight back. ... These challenges are apparent across the healthcare sector, but less than 10 percent of all U.S. doctors have formed unions. The tide is rapidly turning. ... The ranks of AFT’s physicians have already grown at an unprecedented rate—with over 3,200 new members, from New York to Oregon, joining the union over the last year. The AFT is the fastest growing healthcare union and the second-largest nurses union in the U.S.

‘I tried to get into their shoes and their culture’. Care worker experiences in cultural end-of-life care: Interpretative phenomenological analysis Journal of Clinical Nursing / Early View; by Elizabeth Lambert RN, BN (Hons), Jo Gibson RN, BN, PhD, MAdvNsgPrac, Kasia Bail RN, BN(Hons), GCHE, PhD Aim: What are care workers' lived experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care?What does this paper contribute to the wider global community? This study highlights the importance of understanding care workers’ experiences in providing culturally appropriate end-of-life care.

Palliative care nurses share precious lessons learnt after decades working with the dying News.com.au [Australia]; by Jessica Wang; 6/16/24 After taking care of terminal patients who are facing death for 35 years, Sydney nurse Cindy Grundy has learnt a lesson or two about living. Her most cherished is to “guard your time” and treat it like the invaluable commodity that it is, says the palliative care nurse, who works in an inner-city public hospital. “To me, time is everything. It’s so precious,” the 59-year-old said. “You need to learn how to prioritise things and let go of the things that don’t matter. I appreciate the smaller things in life from working in this job but time is a big thing for me.” ... At the heart of what she does, and other palliative care nurses do, is make sure patients can get the most out of the last few hours, days, weeks or months of life – whether that’s through managing their symptoms or fulfilling their last wishes. “They’re dying but they’re still alive and that’s a chance for laughter, love and new experiences,” says fellow Sydney-based nurse Steven Turk.

Dying of heart failure: how do we improve the experience? The Medical Journal of Australia - MJA; by Dominica Zentner, Vithoosharan Sivanathan, Jennifer Philip and Natasha Smallwood; published online 6/17/24 ... Despite the improvements afforded by multiple pharmacological, surgical and interventional developments in heart failure, the goal of therapy remains delayed disease progression for many. Cognisant of this reality, recent heart failure guidelines all highlight the important role of palliative care. ... The MJA recently published an article regarding the imperative of reframing palliative care. ... We suggest that ...

'I don't ever trust Epic to be correct': Nurses raise more AI concerns Becker's Health IT; by Giles Bruce; 6/14/24 Nurses continue to voice concerns about artificial intelligence and its integration into EHRs, saying the technology is ineffective and interferes with patient care. Nurses from health systems around the country spoke to National Nurses United, their largest labor union, for a June 5 story about issues with such programs as automated nurse handoffs, patient classification systems and sepsis alerts. Multiple nurses cited problems with EHR-based programs from Epic and Oracle Health that use algorithms to determine patient acuity and nurse staffing levels. "I don't ever trust Epic to be correct," Craig Cedotal, RN, a pediatric oncology nurse at Kaiser Permanente Oakland (Calif.) Medical Center, told the nurses' union. "It's never a reflection of what we need, but more a snapshot of what we've done." ... Hundreds of nurses protested AI at Kaiser Permanente San Francisco Medical Center in April.

AAHPM CMO Joe Rotella: Hospice does not exist to save money Hospice News; by Jim Parker; 6/17/24Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine (AAHPM), calls on hospices to maintain their core principles amid a churning sea of regulatory and economic changes. Rotella began his medical career as a primary care physician in a small, rural town in central New Hampshire, where he stayed for 12 years [followed by serving Hospice & Palliative Care of Louisville, KY/Hosparus as Chief Medical director for 15 years]. ... Now, Rotella will soon retire from AAHPM. Hospice News sat down with Rotella to discuss the ways hospice and palliative care have changed during his tenure in the space, as well as the forces shaping the field’s future. ...

Why doctors aren’t participating in organ donation after cardiac death Physician's Weekly; by Frank D. Brodkey, MD, FCCM; 6/13/24Organ donation after cardiac death (DCD) differs from the more traditional organ donation after brain death (DBD) insofar that DCD donors are alive and donate organs after discontinuation of life support so that a natural death with cessation of heartbeat and circulation may occur, followed by extraction of organs. This may increase the availability of transplantable organs, leading to improvement in the lives of other humans.  According to the Health Resources and Services Administration, 5896 donations, representing 36% of all donations in 2023, were DCD, representing an increase of 40.7% over the preceding three years. There, however, are significant ethical and scientific issues in the performance of DCD with concepts of end-of-life care, personal autonomy, and concepts of dignity of life and death. ...

Effects of a discourse intervention on end-of-life knowledge and attitudes of Bachelor of Science in Nursing studentsJournal of Hospice & Palliative Nursing; by Haynes, Jayme G. PhD, RN, Dingley, Catherine PhD, RN, FAAN; 6/24The findings indicated increased knowledge and positive attitude changes. This study supports the value of theory-based educational interventions, like a discourse intervention, to enhance effective pedagogy when addressing emotionally laden content such as end-of-life care. This study may have also given a glimpse of how a global pandemic may affect end-of-life knowledge and attitudes.

Hope in oncology: Where art and science collide Medscape; by Sharon Worcester, MA; 6/12/24 Carlos, a 21-year-old, laid in a hospital bed, barely clinging to life. Following a stem cell transplant for leukemia, Carlos had developed a life-threatening case of graft-vs-host disease. But Carlos' mother had faith. "I have hope things will get better," she said, via interpreter, to Richard Leiter, MD, a palliative care doctor in training at that time. "I hope they will," Leiter told her. "I should have stopped there," said Leiter, recounting an early-career lesson on hope during the ASCO Voices session at the American Society of Clinical Oncology (ASCO) 2024 annual meeting. "But in my eagerness to show my attending and myself that I could handle this conversation, I kept going, mistakenly." ... Carlos' mother looked Leiter in the eye. "You want him to die," she said. ...Editor's Note: Click on the title's link to continue reading this insightful reflection and discussion about the importance of "hope." Engage your oncology/palliative/hospice chaplains (hopefully CPE trained and Board Certified) with your medical team members to explore this core belief in "hope." Alert: AI referrals for palliative and hospice care are increasing exponentially. Clinicians must be sensitive to the human dimensions and dynamics of "hope" (which shift and change), and not be driven just by technological data.