Notes from the Nursosphere, Plus a Great Palliative Care Discussion

First: Twitter delivered a treasure this morning, from @abbrody (Ab Brody, an RN — and PhD — in San Francisco):

Wow,just wow! RT @DianeEMeier Pallimed:Post from husband of Dr. Pardi http://bit.ly/a3TH0X Do not miss this discussion! #hpm #palliative

What’s the big deal? Well, the New York Times ran a piece this week about Dr. Pardi, a palliative care doctor who fought it out against her cancer up to the end. The article was fascinating, disturbing, powerful, and we posted about it—and a related article we’d run in AJN not long ago—at this blog a few days ago.

What Brody’s Twitter message alerts us to today is an ensuing post and discussion at the palliative care blog Pallimed. The discussion has none of the harshness of tone one sometimes gets on Web discussions. Many of the people in the palliative care community seem to know each other, which always helps keep things civil (you don’t typically insult people you’re likely to meet in person).

A big question in the discussion is whether the Times story oversimplified the issues, creating an “either/or”  scenario out of something much more complex, and in the process made palliative care look like it’s all about convincing people to give up and die. But it really gets interesting when Dr. Pardi’s husband pops up in the comments section and attempts to clarify some of the questions and misperceptions raised by the Times story. You’ll […]

2016-11-21T13:18:18-05:00April 9th, 2010|nursing perspective|4 Comments
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Disaster Care, Brain Drain, More: Recommended Reading in AJN’s March Issue

The March issue of AJN is now live.

“Nurses play a critical role in disaster preparedness, response, and recovery,” says Linda M. MacIntyre, PhD, RN, PHN, FAAN, chief nurse of the American Red Cross (see On the Cover). Two articles in this month’s issue address disaster care:

Brain drain is increasing in health care. “Original Research: Nurses’ Attitudes Toward Brain Drain and the Associated Factors” explores the attitudes of Turkish nurses, nurse academics, and nursing students toward this problem in the nursing profession.

In this month’s CE article, “Beyond PICO—A New Question Simplifies the Search for Evidence,” the authors present the framework for an alternative to the PICO question—PPCO, or problem, population, change, outcome—that provides a universal approach to question development for evidence-based practice QI initiatives and for all nursing issues that need addressing.

Read

2024-02-26T09:29:37-05:00February 26th, 2024|Nursing|0 Comments
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Preventable and Aggressive Care for Cancer Patients: To the Bitter End

There have been a couple of recent studies that confirm what I have observed as a palliative care nurse practitioner (NP) in an academic medical center: that there’s still a tendency to pursue very aggressive care with older people with cancer. While every situation is different, the evidence shows that people with cancer could also benefit from palliative care and advance care planning to make sure they’re getting the best and right care for them.

Palliative care could prevent many ED visits.

The first study to catch my eye as a former ED nurse was Trends and Characteristics of Potentially Preventable Emergency Department (ED) Visits Among Patients With Cancer in the US. This study reviewed data on almost a billion (854,911,106) ED visits, of which 4.2% were made by patients with cancer. The mean age of those patients, not surprisingly, was 66. The study found that more than half of ED visits among patients with cancer, 51.6%, were identified as potentially preventable, with the absolute number of potentially preventable ED visits increasing substantially between 2012 and 2019.

The authors concluded that this highlights “the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.”

This […]

2023-04-07T09:34:11-04:00April 7th, 2023|end of life, Nursing, palliative care, patient experience, Patients|2 Comments
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April Issue Highlights: Nurses’ Views on Substance Users, Decarbonizing Health Care, More

“I was always the strong one, the one with the answers, the one people came to for advice….” – from the April Reflections essay, “Take Off the Mask: Getting Real About Depression, Trauma, and Loss“

The April issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

CE: How to Write an Effective Résumé

In today’s job market, nursing students and new graduate nurses need to develop an employer-focused résumé geared toward a specific job. This article can assist.

Nurses’ Self-Assessed Knowledge, Attitudes, and Educational Needs Regarding Patients with Substance Use Disorder

This research study’s findings indicate that, “in general, hospital nurses have negative attitudes toward patients with substance use disorder” and are in need of empathy-based education.

AJN Reports: Decarbonizing Health Care

Nurses can be involved in solutions to reduce greenhouse gas emissions in the health sector.

[…]

2023-03-27T08:10:27-04:00March 27th, 2023|climate change, environmental health, environmental health, family caregiving, Nursing, pain management|0 Comments
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Why Spiritual Care?

Staying connected to something greater.

Photo courtesy of Pexels/Pixabay.

In a world that is constantly asking more of us, how can we stay connected to ourselves, to something greater, to a sense of meaning and purpose in our lives? This question guides most of my work, and my personal practices. Across years of conducting mixed-methods research to explore the role of spirituality among people with cancer, I am constantly presented with ways where our connection to spirit is challenged, and ways that we can remain connected amidst the very real pain, challenge, busyness, stress, and burnout of this modern world.

Making time and space for spirituality may seem elusive or impractical, especially when considering the limitations on our time and capacities. Along with co-authors Katie Addicott, MSN, FNP-C, ACHPN, and William E. Rosa, PhD, MBE, AGPCNP-BC, FAANP, FAAN, my hope for this recent piece in the American Journal of Nursing is to highlight simple, practical, and enjoyable ways to incorporate spirituality into everyday life and everyday nursing care, with the intention of supporting our own well-being and the well-being of patients and families we work with.

Defining spirituality 

While various definitions have been offered, “spirituality” generally refers to a human experience of connection with […]

2023-02-21T10:51:33-05:00February 21st, 2023|end of life, Nursing, Palliative care|0 Comments
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Death by PTSD: When Patients Are Afraid of Health Care

“I pleaded with her to go to the hospital.” Don’s voice is suffused with sadness as he sits at the bedside of his dying 39-year-old partner, Clarisse. “She was terrified of medical tests and procedures. By the time she saw a doctor the cancer had spread. She was so overwhelmed she refused any treatments.”

Over the years, I’ve had several patients like Clarisse; younger people who refused to seek medical care or declined treatments that might have cured them. Some were depressed, others worried about the financial burden. But there was a common thread: all were intensely distrustful, avoidant, and afraid.

Depressive thoughts, distrust, avoidance, and fear are all common features of post-traumatic stress disorder (PTSD) and every one of these patients had either been diagnosed with PTSD or would have if they’d sought psychological care.

Effects of PTSD in patient response to health care.

Clarisse had survived childhood sexual abuse at the hands of one of her mother’s boyfriends. This had left her intensely sensitive to intrusions into her personal space, terrified of being touched or probed by medical staff, and distrustful of men and authority figures. There were a number other common effects of PTSD evident in my work with Clarisse.

2023-01-18T09:55:42-05:00January 17th, 2023|Nursing|0 Comments
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In the Nick of Time: Advance Care Planning in the ICU

Marian Grant, palliative care NP

I’m a health policy consultant for national palliative care organizations and often advocate for advance care planning, a process that helps people with serious illness prepare for future decision-making. I also work as a palliative care nurse practitioner (NP) in an academic medical center where I see the real-life aspects of advance care planning.

I recently saw a patient whose case typifies how advance care planning and policies to support it can work. A middle-aged woman with metastatic breast cancer at our cancer center had been seen the day before by the palliative care NP there. The NP was called to help assess the patient’s new-onset dizziness. While seeing the patient, she also spoke to her about her cancer status and suggested completing an advance directive. According to the NP’s note, the patient’s son, who was there with her, seemed surprised that things were not going as well for his mother as they had hoped.

The ‘Five Wishes’ advance directive.

Later in that same visit, the patient became profoundly hypotensive and was sent to the emergency department and then admitted to the medical ICU. The team there put in a request for a palliative care consult for metastatic cancer. I first saw the patient the next morning. […]

2022-09-22T10:08:13-04:00September 22nd, 2022|end of life, Nursing, Palliative care|1 Comment
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The Unsung Heroes of Hospice Are Family Caregivers

Nurses who find their vocation in hospice may be among the most understanding people on earth. As a nurse who has helped many, perhaps hundreds of patients transition into palliative care and hospice, I thought that I would be prepared to handle placing my father into home hospice after a stroke. At 90, my father had vascular dementia due to chronic infarctions. The call from his provider informing me that he had had an embolic stroke with a hemorrhagic component was not completely unexpected. After his anticoagulation was reversed, I knew that he was likely to have another stroke soon.

Walking the tightrope: daughter, nurse, caregiver.

I guess that’s the curse of the nurse. No false hope for me. As the nurse in the family, I walked the tightrope of caregiver, support person, and grieving daughter. The help from the hospice team was extraordinary, but the overall care and responsibility was placed on the family. It was a bit of a shock to me. I can’t imagine how families without members in health care manage.

My father did not pass his swallow test, and he had left-sided paralysis; however, he was initially able to communicate, with some effort. In fact, the priest who saw him on the first day was obviously curious as to […]

2021-01-14T11:15:10-05:00January 14th, 2021|family caregiving, family caregiving, Nursing|2 Comments
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Morphine in Hospice Care: Why Family Members May Resist Its Use

Underlying his concerns was a strong sense of moral responsibility. He was his mother’s protector. He was her voice. He had a duty to keep her safe…

Morphine’s essential place in hospice care.

When I began work in a hospice, I quickly came to see morphine as a wonder drug. It was used so much more effectively in palliative care than with the med-surg patients I had cared for in the hospital!

Morphine can be given via multiple routes, it’s easy to titrate, its side effects are well-known and therefore easy to manage, and it can bring dramatic pain relief as well as markedly improved breathing.

It was common for us to admit patients to hospice whose pain had never been controlled, and they were often dumbfounded at how easily their pain could be managed. The proper medical use of morphine was literally life changing for them.

Addressing family members’ concerns.

As a result of my hospice experience, I’ve always been a big believer in patient and family education to debunk myths and highlight the optimal uses of this drug. And yet education alone isn’t always what family members need when morphine is prescribed for their loved ones. Especially when the patient is at home and it’s a family member, not a nurse, managing […]

2019-11-12T15:36:45-05:00August 21st, 2019|family experience, patient experience|3 Comments
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AJN September Issue: Family Caregivers and Alzheimer’s, Older Adults and Driving, C. Diff. Prevention, More

The September issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE: Original Research: The Experience of Transitioning to a Caregiving Role for a Family Member with Alzheimer’s Disease or Related Dementia

This qualitative study explores the experiences of people who transitioned to the role of caregiver for a family member with Alzheimer’s disease or a related dementia. Vivid interview excerpts illuminate the inner struggles caregivers may experience as they navigate a radically changed existence as well as the strategies that have helped them find their way.

CE: Can Your Older Patients Drive Safely?

Many older Americans depend on their cars for independence and connection to the outside world. What are the driving risks associated with advanced age? What behaviors and situations put older drivers at greatest risk, and what are the key indicators of an older patient’s ability to drive safely? Nurses are in a position to raise patients’ awareness of these risks and inform them about transportation alternatives.

Six Things You Can Do Today to Prevent Hospital-Onset C. Difficile Tomorrow

What changes can you make in your practice to prevent transmission of this common bacterial infection?

Lessons Learned from Litigation: Legal […]

2017-08-25T09:03:28-04:00August 25th, 2017|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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