Literature Review

[Maine] Senate backs safe staffing bill with aim to increase patient safety, decrease nurse burnout Main Morning Star, by Lauren McCauley; 3/27/24 If passed, Maine would be the second state in the country to institute nurse-to-patient ratios. ... Sen. Stacy Brenner (D-Cumberland), who sponsored the bill, shared with the chamber her experience as a nurse and how the stress of being understaffed can contribute to burnout and what she described as “moral distress.” ... Brenner said the bill accomplishes two goals: increasing patient safety and increasing nurse retention. 

“Personhood,” not “Patienthood”:  Tips on dignity-conserving practice in palliative careIAHPC, by Kim Adzich, MD; 4/1/24 One of Dame Cicely Saunders’ foundational tenets of palliative care is embodied in her words, “You matter because you are you, and you matter until the last moment of your life.” Dignity is the inherent worthiness of being human, of mattering until that last breath. But how do we ensure that we reflect that inherent dignity back to those in our care? Dr. Harvey Max Chochinov, having dedicated decades to researching and teaching dignity-conserving care, ... [offers] a few thoughts on how we can foster that sense of dignity and uniqueness in those we care for as they near the end of life. 

Cancer patients often want ‘one more round.’ Should doctors say no? The Washington Post, by Mikkael A. Sekeres, MD; 3/31/24 My patient was in his early 30s and his leukemia had returned again following yet another round of treatment. He was a poster child for the recently reported rise in cancer rates in the young, and had just asked me what chemotherapy cocktail I could devise for him next, to try to rid him of his cancer. I hesitated before answering. Oncologists are notorious for always being willing to recommend to our patients one more course of treatment, even when the chances of success are negligible.  

Code status discussions; difficult but necessary The Hospitalist, by Mark Menet, MD, MPH; 4/1/24 I thought it was just where I practiced, but it turns out that, in the medical field, we’re really bad about having code discussions, which is a significant issue. When some of my patients revealed that no one had ever asked them about their code status before, I decided to conduct some research on this topic. It turns out that, at most, 41% of patients recall discussions about their code status, however, the 10.3% as documented by another study seems much more accurate.

Pediatric Division - National Coalition for Hospice and Palliative Care National Coalition for Hospice and Palliative Care; 3/28/24The National Coalition for Hospice and Palliative Care’s Pediatric Division represents a multi-disciplinary, volunteer team of pediatric palliative care (PPC) leaders. The Division membership is comprised of representatives from all 14 members of the Coalition, three family advocates, as well as representatives from aligned stakeholder organizations including the American Academy of Pediatrics, American Psychological Association, Association for Child Life Professionals, and the State Coalition Network. 

Death is inevitable. Doctors should be prepared to manage it appropriately. MedPageToday, by Gabrielle Kis Bromberg, MD; 3/28/24In preparation for my clinical year, my medical school instructors taught me about the importance of assessing the goals and wishes of patients at the end of life. ... [My Aunt] Daniella shared with my mom and me that she was tired of being so sick and tired of feeling stuck in the hospital's revolving door. So, I asked my aunt the questions I'd just learned in class. "What is most important to you?" "If you were sicker and could not share your own medical wishes, what would you want us to tell your doctors about your goals?" "Would you accept another ICU stay, CPR, a breathing tube?" My mom and I drove home with crystal clear instructions from Daniella. If she got sicker, she wanted to die without prolonged suffering. ... [Months later] Despite many doctors, hospitalizations, a years-long decline, and countless healthcare touch points, no one had asked Daniella how she was faring as her body failed. Why did it require a medical student -- me -- just 4 months into training, to achieve an end of life consistent with her wishes?

Why a Texas system hasn't hired a travel nurse in 30 years Becker's Hospital Review, by Kelly Gooch; 3/28/24 Beth Schmidt remembers the last time Fort Worth, Texas-based Cook Children's Health Care System hired a travel nurse, and it was not recently. ... Many hospitals and health systems increased their reliance on travel nurses during the pandemic to fill vacancies. However, a number of organizations are now making efforts to decrease their dependence for financial reasons. ... [This organization has had 15-20 years success with] the Winter Plan, a program ... [that] allows workers to temporarily become Cook Children's employees for four to six months to help augment the health system's nursing staff. 

From doctor to family: Witnessing both sides of end-of-life care MedPage Today's KevinMD.com, by Jessica Bloom, MD; 3/27/24We all have those moments in medicine when we know that care has become more futile. Then we do everything in our power to educate, support, gently guide, and give permission to patients and families. There are moments that treating for a cure goes against our tenet to “first do no harm.” ... Specialists and his regular physicians sat with us, listened to my family’s questions, and offered kindness along with medical advice. They gently helped my siblings let go of futile searching for treatments. ...

Steward to sell 'highly desired' physician group to Optum Becker's Hospital CFO Report, by Alan Condon; 3/27/24 Dallas-based Steward Health Care plans to sell its physician group to UnitedHealth Group's subsidiary Optum, The Boston Globe reported March 26. The proposed sale of Stewardship Health is part of the 33-hospital system's plan to shore up its finances amid ongoing challenges, including falling behind in paying bills and rents. If approved, physicians who work at Steward facilities across nine states would be employed by Optum, the largest employer of physicians in the U.S.

Fall prevention for the elderly: 13 strategies to keep them safe U.S. News & World Report, by Claire Wolters, ed. by Christine Comizion, MPH; 3/26/24Falls are the leading cause of injury in adults 65 and older – with reports showing about 14 million adults fall each year, according to the Centers for Disease Control and Prevention. ... According to the CDC, falls are also the leading cause of injury-related death in the 65-and-older population – and the fall death rate is growing.Here's what to know about what increases risk for falls in older adults, and get familiar with fall prevention tips and safety measures that can help reduce the risk.Editor's Note: This U.S. News article primes the pump. Preventing falls matters especially for vulnerable hospice patients as their disease progresses, and as they and/or family want the person to be as mobile as possible. What do your Incident Reports tell you about falls? What falls-specific education do you provide for your interdisciplinary teams? On-call staff? Family caregivers? Volunteers? What QAPI programs have addressed falls? 

Bayada invests $375,000 to train future nurses in Pima County Bayada Communications, 3/26/24 Bayada Home Health Care, a nonprofit, global leader in home health care has granted $375,000 to fund nursing education for at least 15 students in Pima County. Tucson’s Bayada Skilled Nursing office ... is partnering with JobPath, a local nonprofit, to support students pursuing Licensed Practical Nurse (LPN) or Registered Nurse (RN) certifications in the greater Tucson area. The grant to JobPath ... will help cover program tuition, books, and other expenses to support those who might otherwise not be able to afford nursing education. 

Expanding the use of continuous sedation until death and physician-assisted suicide  The Journal of Medicine & Philosophy: A Forum for Bioethics and Philosophy of Medicine; by Samuel H Lipuma and Joesph P Demarco; 3/27/24 The controversy over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E) provides an opportunity to focus on a significant extended use of CSD.