Literature Review

Amid trauma and burnout, it ‘takes courage’ to reflect on mental, emotional well-being Healio; by Jennifer Byrne; 7/31/24 ... [William E. Rosa, PhD, MBE, MS] began to realize that in the stressful, devastating situations he and his colleagues faced daily, there was much to be learned from the principles of trauma-informed care. ... “This is the idea that cultivating an awareness can prevent us from re-traumatizing ourselves and others,” he said. “I think it starts with reflecting on — and telling the truth about — our mental and emotional well-being. That takes courage.” In acknowledging the emotional scars, brokenness and vulnerability that comes from tragedy and loss, individuals can begin to heal a lifetime of stored and unresolved trauma, Rosa said. “As a workforce, you and I see unacceptable rates of suicide, burnout, moral distress and attrition,” he said. “It’s time that we come to safe and supported terms with our trauma — not just as individuals, but as a collective, not only for the patients and families we serve, but for us to survive.”Editor's Note: In this article, Dr. Rosa identified "the emotional impact of taking yet another patient off the ventilator at the end of life." Recent articles we've posted in this newsletter about trauma-informed care been in our "Top Reads." While those articles focused on trauma-informed care of the persons you serve, this focuses on the persons who serve, your all-important direct patient care clinicians.

Caregivers of end-of-life patients reveal the last words they hear most often and the most common regrets from patients WhatsNew2Day; by Alexander; 7/27/24... While each person’s final moments are different, chaplains and palliative care nurses have said most people approach their death with “radical acceptance.” People who are actively dying also often have a new sense of clarity about the universe and may even have a temporary burst of energy or sudden moments of clarity if they have dementia. The last words patients usually say to their families are to tell them they love them... [Often, people] who are in the midst of dying want to be surrounded by their loved ones and pets. Their final words are often words of love and pleas for forgiveness, as well as expressions of regret, ... [Another described that people show] "a desire for connection" with loved ones and faith. Editor's Note: This article provides a balanced scope of descriptions from several professionals, notably Catherine Duncan, Annemarie Switchulis, Neal Shah, and Zackary Price. In this day of social media, some hospice professionals (past or present) tout definitive, authoritative descriptions of what all dying persons experience, with too many assumptions and generalizations. Beware what you read and distribute, especially if the tone and language (of other articles) are sensationalized in a way to garner social media "expertise," followers and Shares--at the expense of more balanced, sensitive, diverse, personalized experiences.

Caregiver charged with abusing dementia patient The Freeman, Waukesha County, WI; by Freeman Staff; 7/9/24 A West Allis woman has been charged after she allegedly struck a dementia patient in her care and put a pillow over the woman’s face out of frustration. Erica Junger, 22, was charged Monday in Waukesha County Circuit Court with a count of intentionally abusing a patient, and faces up to six years in prison if convicted. She made an initial appearance in court Monday, where she was released on a $2,500 signature bond and ordered by Court Commissioner David Herring not to work in any job where she is responsible for the health care and safety of others. ... She said she "snapped" and did things she wasn’t supposed to do, but didn’t mean anything by it. ... The complaint did not identify the facility where the incident took place. But it did identify Junger as an employee of Agrace Hospice, which contracts with the facility.

‘Normalizing’ Trauma-Informed Hospice Care Delivery

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.

The latest research indicates massage therapy has benefits from birth to end of life Cision PR Newswire; by American Massage Therapy Association; 6/5/24 The American Massage Therapy Association (AMTA) is sharing recent research on how massage therapy can provide benefits from infancy through end of life. Across all ages, massage therapy can be a therapeutic approach to enhancing physical and emotional well-being. Explore the latest studies on how massage therapy can help improve the quality of life for infants, middle-aged individuals, and older adults. ... A nationwide survey of physicians, physician assistants, and nurse practitioners in palliative care documented recommendation rates of integrative therapies to target symptoms of palliative care patients. The survey found that massage therapy was the third most recommended integrative care modality behind mind-body interventions like meditation and biofeedback. The integrative therapies aimed to reduce pain, anxiety, mood disturbances, and distress.Editor's Note: While hiring a professional massage therapist might not be practical for your budget, explore contracting with massage therapist who is trained in working with medically-fragile persons to provide simple trainings for your nurses and nurse aides. Additionally, professionally trained massage therapists might be interested in volunteering their services, within appropriate parameters (i.e., not transferring the medically-fragile patient to a massage table, having a caregiver present to assist with communication, etc.). 

Improving inclusive palliative care for transgender patients Hospice News; by Holly Vossel; 5/7/24... Nearly a quarter (21.3%) of 865 interdisciplinary palliative professionals indicated that they had observed some form of discriminatory care delivered to a transgender patient in a recent study published in Cambridge University Press’ journal Palliative Support Care. Furthermore, 85.3% of study participants said they witnessed disrespectful care, while inadequate and abusive care was observed by 35.9% and 10.3% of palliative teams, respectively. ... [Read more for descriptions and interventions, as discussed with Zachary Fried, licensed clinical social worker and training supervisor of Optum at Home, a subsidiary of UnitedHealth Group.] 

Terminally ill pediatric patients and the grieving therapist Psychotherapy.net, by Sara Loftin, LPC-S, RPT-S; 4/18/24 A pediatric clinician shares the rewards and challenges of working with terminally ill children and their families. When asked about the favorite aspect of my (dream) job, I could talk for hours. I feel passionate about working in a pediatric hospital setting with chronically ill children and their families. Each day brings new challenges. ... Experiencing the death of a child is the most painful part of my job, and it will never make sense to me although logically, I know this happens. On the other hand, I feel honored to be a small part of the most vulnerable time in a family’s life, and to walk alongside them in their journey of grief and loss. ... It has been impossible for me to not be deeply impacted working in this arena. [This article includes:]

Home care unionization efforts beginning to tick back up Home Health Care News, by Andrew Donlan; 3/25/24 The home care workforce has traditionally been a tough one to organize. But efforts have ramped up over recent years, leading to more workers opting into unions across the country. Recently, University of Rochester Medicine Home Care (URMHC) workers “overwhelmingly” chose to join a labor union. They aligned themselves with 1199SEIU United Healthcare Workers East, which is one of the largest health care worker unions in the country.