Literature Review

Man accused of choking terminally ill wife accepts plea deal KSL.com; by Pat Reavy; 9/27/24 A man who prosecutors say attempted to end his terminally ill wife's life by choking her has accepted a plea deal. DeWayne McCulla, 46, pleaded guilty on Thursday in 5th District Court to an amended charge of attempted manslaughter, a third-degree felony. The charge comes with a domestic violence sentencing enhancement. Arenda Lee McCulla, 47, died on Dec. 21, 2021, following her battle with breast cancer. The night before, however, as a small group of family members were by her side in La Verkin, DeWayne McCulla "choked the victim in an attempt to kill her to ease her suffering while they were with her during her terminal cancer and being on hospice," according to charging documents. Other family members pulled McCulla off of his wife.Editor's note: Crucial information that is not reported in this article: Where was the hospice team in managing this patient's pain? In educating and supporting the caregiver (the husband?) and family about contacting the hospice? In making required visits when the patient is actively dying? In assessing the caregiver's ability to provide care, especially any history or risks of domestic violence, neglect, or abuse? What safety-in-the-home protocols were used by this hospice, especially when hospice team members followed up? Aware of not-knowing these many factors, I do not ask these with judgment but rather to raise awareness of core, preventive measures for other hospice patients.

‘Think like a reviewer’: How hospices can use communication, documentation to boost quality McKnights Home Care; by Adam Healy; 9/24/24 Regulators are tightening their scrutiny of the hospice industry, so providers must prioritize the documentation and communication practices that help them obtain higher quality scores. That’s according to hospice industry experts who spoke during an educational session at the National Hospice and Palliative Care Organization’s annual meeting in Denver. “They’re looking closely at the hospice industry,” Angela Huff, senior managing consultant at Forvis Mazars, said last week during the conference. “They have increasing concerns about fraud, waste and abuse in this space. … Don’t think this is going to stop.” ... A key part of hospice quality assurance is communication, Gallarneau said. Providers should support open, friendly channels of communication. This helps staff and clients feel comfortable raising concerns, making quality issues easier to tackle quickly and effectively. Also, prioritizing accuracy in documentation will help providers stay ready for any surveys or audits, Gallarneau noted. Hospices should ensure patient consent and election of benefit forms are properly filled out, signed and dated, and staff should all be trained to do so accordingly. 

The evolving landscape of Amyotrophic Lateral Sclerosis: A fatal disease!  Delveinsight; 9/24/24 Amyotrophic Lateral Sclerosis (ALS) is a devastating neurodegenerative disease characterized by the progressive degeneration of motor neurons, leading to muscle weakness, paralysis, and ultimately, death. ... Despite ALS being relatively rare, affecting 2-5 per 100,000 people worldwide, the question Is ALS on the rise? is gaining attention. While global prevalence has not significantly increased, improved diagnostic techniques, earlier detection, and greater awareness have led to a more accurate identification of ALS cases. Many researchers believe that enhanced surveillance and better tools for genetic testing are uncovering more cases than previously recognized, rather than a true rise in the disease’s incidence. However, with an aging global population, the burden of ALS may grow, as age is a major risk factor. Editor's note: Do you provide disease-specific training for your staff? ALS patients' and families' needs are unique. A significant disease comparison is between ALZ (Alzheimer's) and ALS. With ALZ (Alzheimer's), the brain decreases its abilities to function while the body can remain strong; the person is mobile with cognitive limitations. In contrast, with ALS, the body decreases its abilities to function while the brain/mind/emotions can remain strong. The person is immobile with cognitive awareness, but extreme physical limitations in communicating one's thoughts, emotions, and needs. ALS-specific communication tools provide crucial help for all. For more information in your location, visit The ALS Association's USA map.

How can we make dementia care more human? Practical insights for providers. CHAP - Community Health Accreditation Partner; by Jennifer Kennedy, PhD; 9/20/24 This year’s World Alzheimer’s Day brings a renewed focus on advancing dementia care, especially with the recent launch of the CMS GUIDE Model. This groundbreaking approach emphasizes comprehensive, coordinated care, not only improving the lives of patients but also significantly easing the burden on caregivers. As healthcare providers, there’s a critical opportunity to adopt strategies that go beyond clinical treatment, focusing on the human experience and addressing the emotional, physical, and financial challenges that dementia brings. ... As we reflect on the progress made in dementia care, there are several actionable strategies healthcare providers can implement to enhance their programs:

Death is no enemy Psychiatric Times; by Sidney Zisook, MD; 9/17/24... As mental health clinicians, we often confine our conversations about death and dying to recognizing suicide risk and preventing suicide. And for good reason. Suicide is the 11th leading cause of death in the United States, ... Far less attention is paid by mental health clinicians to other aspects of death and dying. But we are human, first and foremost, and coping with a host of issues related to the end of life is inextricably bound to both our professional and personal lives. Like it or not, death is part of life. We, as mental health clinicians, are not always as prepared as we would like to be to help ourselves, our loved ones, our patients, and their loved ones deal with loss, dying, death, and bereavement. For many physicians, 1 or 2 hours in medical school and perhaps another few hours during residency are all the training we receive in these complex and challenging clinical issues. ...  Chochinov provides a clinician’s guide for “being with” dying patients. He offers ways of providing intensive caring to enhance empathy, respect, connectivity, and hope, and to make the experience of a dying patient more tolerable than it otherwise might be. ... I have utilized his Patient Dignity Question, which asks, “What do I need to know about you as a person to take the best care of you possible?” on several occasions with gratifying results for both the patient and me.

Global collaboration launches culturally inclusive palliative care education tool Hospice News; by Holly Vossel; 9/16/24 An international collaboration has led to the development of a new palliative care training tool aimed at improving quality and equitable access. Health systems across the globe are recognizing a growing need to boost the supply of providers able to care for a swelling, aging population of serious and terminally ill patients. Rising demand was among the driving forces behind the newly unveiled COllaboratively DEveloped culturalY Appropriate and inclusive Assessment tool for Palliative Care Education (CODE-YAA@PC-EDU). The palliative care education tool was developed in concert by the Council of Europe, the World Health Organization (WHO) and the United Nations. The organizations joined forces to design a sustainable training model that could build up the palliative workforce. The project is supported in part by the research network European Cooperation in Science and Technology (COST).

The 9 college majors that lead to the most fulfilling careers ... NBC 7 San Diego, CA; by Kamaron McNair; 9/14/24 If you want your degree to help you land a fulfilling job, consider studying music therapy. The medical and therapeutic fields are among the college majors helping graduates get jobs that make the world a better place, according to graduates surveyed in a recent Payscale report.24/7 San Diego news stream: Watch NBC 7 free wherever you are Alumni with bachelor's degrees in music therapy are most likely to do this kind of fulfilling work, with 95% of degree-holders saying their work makes the world a better place, Payscale finds. Music therapy programs cover coursework in music, music therapy, science and psychology, according to the American Music Therapy Association. ... Music therapists may work in traditional settings, offering services to clients working through physical disabilities or mental health issues. People in hospice care, substance abuse programs and cancer treatment centers have also benefited from music therapist visits, according to the AMTA.Editor's note: Click here for facts and descriptions about "Music Therapy in Hospice Care," by the American Music Therapy Association (AMTA). To recruit a certified music therapist for hospice (or other setting), visit AMTA's Job Hotline.  

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. ...

When rounding sparked improvements, per 4 chief nursing officers Becker's Hospital Review; by Erica Carbajal; 9/5/24 Rounding the floor with front-line nurses and staff is more than just a management practice for leaders to show face — it is a vital tool for connecting with employees and driving meaningful change. In conversations with hospital leaders, they often echo the sentiment of how routinely spending time with front-line staff uncovers opportunities to address pain points in their daily workflow. With nurses often pointing to lack of resources and support as drivers of job dissatisfaction and burnout, rounding represents a key strategy to positively affect staff engagement and retention, and thus, patient care. Becker's recently asked four chief nursing officers to share a recent example of a time when rounding sparked a process change or improvement at their hospital. Here are their responses: ... Editor's note: "Rounding" best practices and outcomes apply to hospice and palliative care multidisciplinary teams. 

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."

Hospice workers help patients with last wishes St. Joseph News-Press, MO; by Charles Christian; 9/1/24 While expressing last wishes is not always the first priority for hospice patients, caregivers say it can be a helpful and meaningful step in the grief process. Registered nurse Kathy Lewis, a hospice care manager at Freudenthal Home-Based Healthcare, said that although asking about last wishes is part of the intake process for many hospice organizations, it is not always something that patients and families share right away. "I typically don't ask about last wishes during an admission," Lewis said. "But once I get to know them, and they feel comfortable with me ... that's when they tend to disclose things like that, because it is a very personal thing." Once disclosed, social workers, nurses, chaplains and other members of a treatment team do what they can to fulfill these wishes. Licensed social worker Jenny Dryburgh said that for bigger wishes, creativity becomes a key factor. ...

How to recognise the dying phase in palliative and end-of-life care Nursing Times; by Julie Kinley and Cathriona Sullivan; 8/19/24This article gives practical guidance for nurses on providing care in the last days of life. ... Birth and death are two certainties in life. Consequently, during their career, many nurses will support, and indeed lead, the management of the care of dying people. ... [Knowing] how to recognise – and manage – this phase of life remains a career-long key responsibility and role. ... In any setting, nurses are part of a wider team. The recognition of dying and the dying phase can be enhanced if everyone: