Recent End-of-Life Care Links of Note, by Nurses and Others

nature's own tightrope/marie and alistair knock/flickr creative commons nature’s own tightrope/marie and alistair knock/flickr creative commons

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

End-of-life care and decision making have been getting a lot of attention lately. The Institute of Medicine released a new report earlier this year, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (available for free download as a PDF).

Nurses who write often write about end-of-life matters. A couple of recent examples:

On the Nurse Manifest Web site, a look at the realities and challenges of futile care in America. Here’s a quote:

“I am currently teaching a thanatology (study of death and dying) course for nurses that I designed . . . to support students to go deeply in their reflective process around death and dying, to explore the holistic needs of the dying, and to delve into the body of evidence around the science and politics of death and dying.”

Or read another nurse blogger’s less abstract take on the tricky emotional territory nurses face when a patient dies.

Elsewhere on the Web
Vox reporter Sarah Kliff collects five strong end-of-life essays that recently appeared in various sources.

And here’s something very practical that might catch on: according to a recent NPR story, a Honolulu hospital offers patients and their family members instructive videos on the sometimes gruesome realities of some end-of-life treatment options. Starting with the no-sugar-coating-it statement, “You’re being shown this video because you have an illness that cannot be cured,” these videos explain intubation, CPR, and the different care options available.

I really liked this piece because the physician admitted that he was ill prepared to talk to a patient running out of options who he had never met before. Then he remembered the counsel of other professionals to give patient-specific care (“What are your goals for your care?”).

And some recent coverage in AJN or on this blog
Joy Jacobson’s short end-of-life and palliative care overview from 2013. […]

Missed Empathy, Missed Care: Is It Time to ‘Reconceptualize Efficiency’?

A physician’s lament is nursing’s, too.

By Maureen Shawn Kennedy, AJN editor-in-chief

By Alan Cleaver/via Flickr By Alan Cleaver/via Flickr

Last week, the New York Times Well blog published “The Importance of Sitting With Patients” by Dhruv Khullar, a Harvard medical resident. Khullar expressed regret over not spending more time with a patient who was near death, and then discussed how little time residents actually spend with patients—eight minutes, according to a Journal of General Internal Medicine study (2013) that analyzed the time of 29 interns over a month. (The study found that only 12% of the residents’ time was spent on direct patient care; 40% of their time was spent on computers.)

Khullar detailed the various activities that take him away from direct patient contact and noted as well that the shorter working hours mandated for residents had the unintended consequence of reducing time with patients. He wondered:

By squeezing the same clinical and administrative work into fewer hours, do we inadvertently encourage completion of activities essential in the operational sense at the expense of activities essential in the human sense?

The second part of the question seemed especially pertinent for nurses. Hospital nurses have long lamented that paperwork, insufficient staffing, and nonnursing tasks keep them from the bedside. The promise of computers to reduce documentation time has yet to be realized, as first-generation documentation systems are not necessarily designed from a nursing perspective and often lack the specificity and flexibility to truly capture nursing activities. […]

At the Intersection of Hospice and Obstetrics, a True Test of Patient-Centered Care

By Jacob Molyneux, senior editor

Renee Noble with her newborn daughter, Violet. Photo by Heidi Ricks. Renee Noble with her newborn daughter, Violet. Photo by Heidi Ricks.

We’d like to draw attention to a particularly frank and thought-provoking article in the October issue of AJN. “A Transformational Journey Through Life and Death,” written by a perinatal nurse specialist who is also a bioethicist, describes a hospital’s experience in meeting the needs of a patient with two very different, potentially conflicting, medical conditions.

It was a sunny afternoon in mid-October when I first met Renee Noble. I had already heard about her from staff who had given Renee and Heidi Ricks, her friend and doula, a tour of the neonatal ICU and were taken aback when they asked to see the Hospice Inn as well. The nurses knew that Renee had been diagnosed with ovarian cancer, but no one had said anything about it being terminal. Heidi had insisted that after Renee delivered she would need hospice inpatient care. Alarmed, the staff had called me, the perinatal clinical nurse specialist, after Renee and Heidi left.

In addition, this is a patient with strong preferences about her own care, preferences that may be at odds with the more conventional approaches to treatment held by many nurses and physicians. […]

AJN in October: Getting Inpatients Walking, Calciphylaxis, Nurses and Hurricane Sandy, More

AJN1014.Cover.OnlineAJN’s October issue is now available on our Web site. Here’s a selection of what not to miss.

Calciphylaxis is most often seen in patients with end-stage renal disease. “Calciphylaxis: An Unusual Case with an Unusual Outcome” describes the rare case of a patient diagnosed with calciphylaxis with normal renal function, and how the nursing staff helped develop and implement an intensive treatment plan that led to the patient’s full recovery. This CE feature offers 2.5 CE credits to those who take the test that follows the article. To further explore the topic, listen to a podcast interview with the author (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

The adverse effects of bed rest. Prolonged periods of immobility can have adverse effects for patients, such as functional decline and increased risk of falls. “A Mobility Program for an Inpatient Acute Care Medical Unit” describes how an evidence-based quality improvement project devised for and put to use on a general medical unit helped mitigate the adverse effects of bed rest. This CE feature offers 2 CE credits to those who take the test that follows the article. […]

September 30th, 2014|Nursing, nursing perspective, nursing research|0 Comments

AJN’s August Issue: Preventing Pressure Ulcers, Strengths-Based Nursing, Medical Marijuana, More

AJN0814.Cover.OnlineAJN’s August issue is now available on our Web site. Here’s a selection of what not to miss.

Toward a new model of nursing. Despite the focus on patient-centered care, medicine continues to rely on a model that emphasizes a patient’s deficits rather than strengths. “Strengths-Based Nursing” describes a holistic approach to care in which eight core nursing values guide action, promoting empowerment, self-efficacy, and hope. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Decreasing pressure ulcer incidence. Hospital-acquired pressure ulcers take a high toll on patients, clinicians, and health care facilities. “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment” describes how one of the world’s largest and busiest cardiac hospitals implemented several quality improvement strategies that eventually reduced the percentage of patients with pressure ulcers from 6% to zero. This CE feature offers 2.8 CE credits to those who take the test that follows the article. And don’t miss a podcast interview with the authors (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

Read our Cultivating Quality column this month for another article on using evidence-based nursing practice to reduce the incidence of hospital-acquired pressure ulcers and promote wound healing. […]

August 1st, 2014|Nursing, nursing perspective, nursing research|0 Comments