Literature Review

When families fight over a relative with dementia, it’s time to call in the mediator The New York Times; by Paula Span; 5/13/24 Trained negotiators can help families struggling with vexing elder-care issues.  The four adult children were in agreement. Their father, William Curry, a retired electrical engineer and business executive, was sinking deeper into dementia. ... [But their mother] remained determined to continue caring for her 81-year-old husband at home, despite the increasing toll on her own health. ... As the weeks passed, “we were really at an impasse,” [a daughter] said. “Do you override your mother?” ...  [Increasingly,] families seek elder mediation privately, before disputes land in court and imperil or destroy family relationships. [Continue reading for descriptions of how mediation differs from arbitration, from family therapy, and for cautions about this being "a fairly new field with no nationwide certification or licensing requirements."]Editor's Notes: Executive leaders, what community education and resources are you providing for Advance Directives? What family systems education and and problem-solving are you providing for your interdisciplinary team members and grief counselors? Family conflicts are inherent--in some form or fashion--with almost anyone needing dementia care, especially when paired with palliative or hospice care. (If in doubt, ask your seasoned, front-line professionals.)

Nurse practitioners improve skilled nursing's dementia care outcomes, but regulatory barriers remain: studyMcKnights Long-Term Care News; by Josh Henreckson; 5/13/24[Nurse pracitioners'] NPs’ involvement can significantly improve end-of-life care outcomes for residents with Alzheimer’s disease and related dementias (ADRD), according to the results of a new study in JAMA Health Forum. ... Those benefits, however, were shrunk by state regulations on the scope of care NPs are allowed to provide. ...  Elizabeth White, PhD, assistant professor of health services, policy and practice at Brown University [describes,] “For example, when a state restricts NPs from signing Do Not Resuscitate orders, that can serve as a barrier to advance care planning and could contribute to unnecessary hospitalizations at the end of life.” Editor's Note: We posted this JAMA Health Forum article on : Nurse Practitioner care, scope of practice, and end-of-life outcomes for nursing home residents with dementia. 

6 ways to cut EHR burdens for physicians AMA - American Medical Association; by Sara Berg, MS; 5/7/24 When Jane F. Fogg, MD, MPH, first became a doctor, patient charts were on paper. She looked forward to the rise of the EHR, believing electronic charting could help modernize the care she provided while also empowering herself and her patients. Funny how things turn out. “EHRs are a source of burnout—we have lots and lots of great evidence that has helped us understand the low usability and the high work burden that it adds to physicians,” Dr. Fogg, senior physician adviser at the AMA. ... Here are just a few ways that health systems and organizations can improve EHR workflows to reduce physician burden.

A narrative review of risk mitigation strategies in the management of opioids for chronic pain and palliative care in older adults: interprofessional collaboration with the pharmacist Annals of Palliative Medicine; by Insaf Mohammad, Candice L Garwood, Lisa Binns-Emerick Key content and findings: A variety of risk mitigation strategies to improve safety for older adults using opioids exist. They include risk assessment, tapering opioids, reducing high-risk concomitant medications, utilizing non-opioid therapies, screening for and treatment of opioid use disorder (OUD), toxicology testing, co-prescribing naloxone, utilizing controlled substance agreements, reviewing prescription drug monitoring program data, prescriber and patient education, and collaboration with pharmacists and palliative care specialists.

Top ten tips palliative care clinicians should know about the psychiatric manifestations of nonpsychiatric serious illness and treatments Journal of Palliative Medicine; by Gregg A Robbins-Welty, Paul A Riordan, Daniel Shalev, Danielle Chammas, Paul Noufi, Keri O Brenner, Joshua Briscoe, William E Rosa, Jason A Webb; 5/10/24... Among patients receiving palliative care (PC), psychiatric comorbidities are common and impact patient quality of life. ... This article, created collaboratively with a team of psychiatric-palliative care experts, is the second in a two-part series examining the bidirectional relationship between medical and psychiatric illness in PC. This article explores 10 prevalent psychiatric manifestations associated with severe illness and its treatment. [Additional access requires journal subscription or additional payment]

Impact of implementing serious illness conversations across a comprehensive cancer center using an interdisciplinary approach The American Journal of Hospice & Palliative Care; by Karen Guo, Garrett Wasp, Maxwell Vergo, Matthew Wilson, Megan M Holthoff, Madge E Buus-Frank, James J Perry, Amelia M Cullinan; 5/10/24Objectives: (1) Increase Serious Illness Conversation (SIC) use across oncology teams via an interdisciplinary quality improvement (QI) approach and (2) assess patient reported shared decision making (SDM) experiences with clinicians engaged in SIC implementation.Results: Oncology teams screened a total of 538 patients, identified 278 eligible patients, and completed 144 SIC conversations. The teams improved the proportion of documented SIC among eligible patients from near 0% to a collective frequency of 52%.

[Honoring Nurses Week] Too many nurses are being assaulted. Some say they are being blamed for the attacks. Chief Healthcare Executive; by Ron Southwick; 5/9/24 With disturbing regularity, nurses in hospitals and other healthcare settings are being physically assaulted and verbally harassed. More than half of emergency nurses say they’ve been assaulted or threatened within the past 30 days, according to the Emergency Nurses Association. In a separate study, researchers found that healthcare workers faced at least one violent or aggressive incident for every 40 hours worked, according to findings published by The Joint Commission Journal on Quality and Patient Safety. With the observance of National Nursing Week, the increased violence in healthcare can’t be ignored. Nursing leaders say the regular exposure to violence or threatening behavior is one factor adding to stress and burnout of nurses and, in some cases, spurring them to seek new jobs.

Honoring National Nurses Week: 11 hospital executives' thank-you notes to nurses Becker's Clinical Leadership; by Mariah Taylor and Kelly Gooch; 5/6/24 The American Nurses Association's theme of National Nurses Week, "Nurses Make the Difference," highlights nursing excellence and how nurses embody the spirit of compassion and care in every healthcare setting. ... [Click on the title's link for] Becker's collected messages of appreciation from hospital and health system leaders across the U.S. ...

Hospice Certifying Physician Medicare Enrollment InformationPalmetto GBA email; 5/6/24Pursuant to our authority under section 6405 of the Affordable Care Act, and as part of CMS' larger strategy to address hospice program integrity and quality of care, certifying physicians, including hospice physicians and hospice attending physicians, must be enrolled in or opted-out of Medicare for the hospice service to be paid. Effective June 3, 2024, (delayed from May 1, 2024) CMS will begin implementing edits to enforce this new rule and will deny hospice claims if the physician entered in the Attending field on the claim is not in the Provider Enrollment Chain and Ownership System (PECOS) as an enrolled or opted-out physician.

Let us never consider ourselves finished nurses ... we must be learning all of our lives. - Florence Nightingale, 1820-1910Editor's Note: Executive leaders, what ongoing learning do you provide for your nurses? Do you simply give directives (which are important) or do you also foster the individual's curiosity, confidence, and increased competence? Whatever your hospice and palliative role, discipline, and education, may we ALL be learning, all of our lives. Celebrating National Nurses Week, May 6-12, 2024

Early-career physicians working temp roles to 'test drive' practice settings, survey finds Becker's Hospital Review; by Alan Condon; 5/3/24Physicians and advanced practice providers are opting for the flexibility of temporary, locum tenens work in seek of improved job conditions and to relieve burnout, according to an April 23 survey conducted by AMN Healthcare. AMN, the largest provider of healthcare interim leadership and executive search services in the U.S., asked physicians, physician assistants and nurse practitioners who recently have worked locum tenens why they do so. The number one reason, according to 86% of respondents, was a better work schedule, followed closely by addressing feelings of burnout (80%).

Honoring Nurses Week: Workplace factors that are 'extremely important' to nurses Becker's Clinical Leadership; by Mariah Taylor; 5/6/24 ... The survey asked nurses how important different elements of the workplace were. Here are the six elements of the workplace with the percentage of nurses who said it was "extremely important":

National Nurses Week 2024: RN reflects on the state of the profession, calls for change USA Today / Columbia Daily Tribune; by Julia Gomez, USA Today; 5/6/24 Monday, May 6 kicks off National Nurses Week, and it gives folks an opportunity to show their love and appreciation for the people who take care of the sick, injured and dying. From neonatal nurses who help welcome newborns into the world to hospice nurses that provide peace and comfort to their dying patients, nurses play a crucial role in the medical industry. ... Catherine Kennedy, a registered nurse and the Vice President of National Nurses United, told USA TODAY that there needs to be systemic change on the federal level to give nurses the best chance to care for their patients. A study published by the National Library of Medicine states that in 2021, nurses would work an average of "8.2 hours of paid overtime and 5.8 hours of unpaid overtime per week that year — making up the equivalent of more than 9000 full-time jobs." ...