WELCOME TO SUMMA'S RESOURCE PAGE FOR THE SCHWARTZ CENTER ROUNDS.
Look below for further reading on topics
discussed at the Rounds
brought to you by the Summa Medical Library
This month's Schwartz Rounds was slightly different. As I listened to the panel and the discussion afterwards, the word I heard the most was compassion. Instead of focusing on first year experiences, here are some articles on compassion and health care workers.
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Full text available at the link above.
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The article presents practical advice for nursing staff in dealing with disruptive behavior from patients' family in the U.S. It explains why family members feel the need to set the patient's agenda, and understanding the reasons, such as stress, anxiety or guilt can help diffuse difficult situations. It suggests not taking the behavior personally and focus on developing a therapeutic relationship with the patient's family. It warns against signs of potential violence such as agitated behavior and to have a plan to alleviate a difficult situation.
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Describes the case of Evelyn, a woman with terminal cancer, who does not want to accept that she is dying and how nurses tried to help cope with her disease. Background on the patient's family and childhood; Description of how nurses managed the patient's neurologic symptoms; Evelyn's denial of her terminal condition as a way of coping with the disease.
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Situations involving agitated patients are not uncommon in health care settings. And no matter where on the spectrum an incident involving an agitated patient falls, it can leave those involved with various levels of physical, emotional, and psychological harm. It can also leave everyone asking themselves: "How can I better prepare for such occurrences?" This article offers some answers by providing tips and guidelines for handling agitated and/or violent patients in various settings. [ABSTRACT FROM AUTHOR]
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Summa researchers have published one of the feature articles in the October issue of American Journal of Nursing.
The article, which describes the genesis of the enABLE training program, is titled, Workplace Violence Training Using Simulation.
Authors are: Brown, Robin G., BSN, RN, CHEP; Anderson, Shauna, MSN, RN, NE-BC; Brunt, Barbara, MA, MN, RN-BC, NE-BC; Enos, Trish, BS, BSN, RN, CPHQ; Blough, Keith, MBA; Kropp, Denise, BS, CCRP
CLICK THE LINK BELOW TO GET TO THE ARTICLE! (must use library ID from off campus)
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The article reports that the U.S. Joint Commission on Accreditation of Healthcare Organizations has urged health care facilities to reduce workplace violence against staff members and released an infographic that details violent incidents and harassment experienced by workers.
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The article discusses how health care systems in the U.S. are working to prevent violence against their workers
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The article focuses on aspects of the adoption of security practices at hospitals in the U.S.. It explores the finding of the survey conducted by the professional organization American Society for Health Care Engineering which shows an increase in violence against employee personnel in 2018 and the strategies of controlling visitors in hospitals.
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Article Title: MUNCHAUSEN BY PROXY--THE DEADLY GAME.
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Focuses on the psychiatric disorder of mothers called Munchausen by proxy syndrome (MBPS).
Article Title: Munchausen Syndrome by Proxy
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Guidelines for law enforcement officers and emergency medical services personnel in determining MSBP; Reasons for removing a child from the custody of a parent with MSBP; Origins of evidence of MSBP behavior presented in a custody hearing.
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Article Title: A Different Kind of Health Care Crisis: Suicide rates continue to rise; the question is why? For full text, click the PDF link on the left side of the subsequent screen.
The article discusses the increasing suicide rates.
Article Title: Public health steps up to curb rising suicide rates For full text, click the PDF link on the left side of the subsequent screen.
The article discusses the efforts of public health in the U.S. to address the rising number of suicide deaths.
Article Title: Suicide Awareness Needed for Bhutan Refugees in United States For full text, click the PDF link on the right side of the subsequent screen.
High reported suicide rates among Bhutanese refugees resettled in the United States point to the need for job training and language skills programs that include social support and mental health components.
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Article Title: "No small talk please, my baby's just died".– For full text, click the PDF link on the right side of the subsequent screen.
A woman reflects on the ways healthcare professionals can help make miscarriage less devastating.
Article Title: Someone I love was never born For full text, click the PDF link on the left side of the subsequent screen.
The article discusses miscarriages and stillbirths and grieving strategies following these incidences.
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Article Title: Approach to caring for developmentally disabled adults in the community
Article Title: Promising Practices for incident management: How We Can Keep Vulnerable Citizens Safe For full text, click the PDF link on the left side of the subsequent screen.
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Article Title: An Uninsured Immigrant Delays Needed Care - For full text, click the article title and then click the 'PDF' link under 'Tools' on the right side of the subsequent screen.
Bettigole, C. (2015). An uninsured immigrant delays needed care. Health Affairs, 34(12), 2092-2195.
A physician reflects on the bitter reality of delayed and denied care that her immigrant patient faced more than a decade ago and that many immigrants still face today.
Article Title: A Complete Academician. A Patient Encounter Shows a Doctor He Still Has Much To Learn. – For full text, click the PDF link on the left side of the subsequent screen.
Prashanth, G. P. (2012). A complete academician. A patient encounter shows a doctor he still has much to learn. Medical economics, 89(3), 66-68.
Gowda Parameshwar Prashanth, MBBS, MD, was a postgraduate student in the final year of his pediatrics residency at of one of India's most prestigious medical institutions when his life changed.
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Article Title: Improving the Health of the Homeless: Advice for Physicians - For full text, click the article title; then click the PDF link on the left side of the subsequent screen..
Lipato, T. (2012). Improving the health of the homeless: advice for physicians. Minnesota medicine, 95(2), 45-50..
Homeless individuals suffer from a constellation of health issues, experience barriers to medical care that are both recognizable and hidden, and score worse on measures of health outcomes than the general population. They differ to such an extent from the general population that homeless people should be viewed by clinicians as a unique patient population. Improving the health of this population is difficult for a number of reasons. This article explores those reasons. It describes common conditions affecting homeless people and discusses how patient-centered comprehensive primary care, collaboration between health care providers and social service organizations, and innovative delivery of medical respite services can result in better care for this population.
Article Title: Patient-Centered Medical Home and Diabetes - For full text, click the article title. For article in PDF format, click the PDF link on the right side of the subsequent screen.
Bojadzievski, T., & Gabbay, R. A. (2011). Patient-centered medical home and diabetes. Diabetes Care, 34(4), 1047-1053..
The current model of health care delivery is designed to address acute health problems and is based on episodic face-to-face interactions between health care provider and patient, which often do not address the needs of chronically ill individuals… The Patient-Centered Medical Home (PCMH) has been proposed as a practical solution to the primary care crisis and holds promise to deliver better chronic care. Diabetes lends itself well to the principles of the PCMH given its robust evidence -based guidelines, high cost, and well demonstrated quality gap.
Article Title: Coordinated Care of Medically Complex Individuals in an Individual-Centered Medical Home: The Surprising Cas of Mr. and Mrs. W - For full text, click the article title; then click the PDF link on the left side of the subsequent screen.
Hart, K. M. (2015). Coordinated Care of Medically Complex Individuals in an Individual‐Centered Medical Home: The Surprising Case of Mr. and Mrs. W. Journal of the American Geriatrics Society, 63(1), 173-174.
When I met Mr. and Mrs. W 2 years ago, I knew immediately they were going to be a challenge. Both in their late 70s, they had a multitude of illnesses...It became clearer and clearer that they could not care for themselves and that I could not help them alone. I referred them to our new Care Coordination Team, composed of three social workers, a case manager, and a pharmacist. Tired of being sick and scared, Mr. and Mrs. W welcomed their help. The team checked in with them regularly and met with me weekly to update me on their progress.
Article Title: Health Care for Homeless and Unstably Housed: Overcoming Barriers - For full text, click the article title; then click the PDF link on the left side of the subsequent screen..
Rabiner, M., & Weiner, A. (2012). Health care for homeless and unstably housed: overcoming barriers. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 79(5), 586-592.
The causes of homelessness are complex and multifactorial and the solutions equally complex. Though homelessness is not a disease process, it is directly linked to poor health outcomes. It is thus incumbent on health care professionals to know the various definitions of homelessness, the ramifications of unstable housing, and the specific living conditions of each homeless patient. These factors needed to be accounted for when designing treatment plans in a way that will increase access to care and promote adherence. Increasing compliance and addressing barriers to care will improve outcomes and may reduce overall health expenditures.
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Article Title: Role of Kindness in Cancer Care - For full text, click the article title. You may use the Print PDF or Download PDF links right above the window that displays the first page of the article.
Berry, L. L., Danaher, T. S., Chapman, R. A., & Awdish, R. L. (2017). Role of Kindness in Cancer Care. Journal of Oncology Practice, DOI: 10.1200/JOP.2017.026195.
Simple kindnesses can help to diffuse negative emotions that are associated with cancer diagnosis and treatment-and may even help to improve patients' outcomes. On the basis of our experience in cancer care and research, we propose six types of kindness in cancer care: deep listening, whereby clinicians take the time to truly understand the needs and concerns of patients and their families; empathy for the patient with cancer, expressed by both individual clinicians and the care culture, that seeks to prevent avoidable suffering; generous acts of discretionary effort that go beyond what patients and families expect from a care team; timely care that is delivered by using a variety of tools and systems that reduce stress and anxiety; gentle honesty, whereby the truth is conveyed directly in well-chosen, guiding words; and support for family caregivers, whose physical and mental well-being are vital components of the care their loved ones receive.
Article Title: Kindness: at the Center of Patient Experience Strategies - For full text, click the article title and then click the green PDF button on the right side of the subsequent screen.
Padilla, T. (2017). Kindness: At the Center of Patient Experience Strategies. Journal of Healthcare Management, 62(4), 229-233.
In 2007, UCLA Health became the first healthcare organization (to my knowledge) to include "kindness" in its vision statement: "Healing humankind, one patient at a time, by improving health, alleviating suffering, and delivering acts of kindness." This singular inclusion was the key to transforming our culture into one centered on our patients' experience.
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Article Title: Closing the Mortality Gap -- Mental Illness and Medical Care - For full text, click the article title and then click the 'PDF' link under 'Tools' on the right side of the subsequent screen.
Rosenbaum, L. (2016). Closing the Mortality Gap—Mental Illness and Medical Care. New England Journal of Medicine, 375(16), 1585-1589.
The first time I spoke with Gail Levine, an internist whose practice at Boston’s Brigham and Women’s Hospital is devoted to patients with severe mental illness, she said something that still nags at me...."“You realize,” she said, “that patients with severe mental illness die, on average, at age 53. This is one big reason why. Doctors assume that because he has mental illness, he has no quality of life. You can’t just let him refuse.”
Article Title: Assessing Patient Decision-Making Capacity: It's About the Thought Process - For full text, click the article title and then click the PDF link under 'Files' on the left side of the subsequent screen.
Mitchell, M. A. (2015). Assessing Patient Decision-Making Capacity: It’s About the Thought Process. Journal of Emergency Nursing, 41(4), 307-312.
It is a common occurrence for patients to leave AMA in the emergency department, and thus it is imperative that emergency nurses know how to effectively assess and communicate a patient’s DMC in order to appropriately advocate for the patient. Taking the time to talk with patients to understand how they have made their choice(s) is foundational to this advocacy and assessment. This process can be difficult and may seem counterintuitive in the fast-paced environment of an emergency department, where time is a rare commodity.
Article Title: Practice of Informed Consent - For full text, click the article title and then click the green 'Download PDF' button on the right side of subsequent screen
Quallich, S. A. (2004). The practice of informed consent. Urologic Nursing, 24(6), 513-5.
This article describes the basics on the topic of informed consent.
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Article Title: Barriers to healthcare for transgender individuals - For full text, click the article title and then click the 'PDF' link under 'Formats' on the right side of the subsequent screen.
Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current Opinion in Endocrinology, Diabetes and Obesity, 23(2), 168-171..
The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers.
Article Title: The mental health of older LGBT adults - For full text, click the article title and then click the PDF link on the left side of the subsequent screen.
Yarns, B. C., Abrams, J. M., Meeks, T. W., & Sewell, D. D. (2016). The mental health of older LGBT adults. Current psychiatry reports, 18(6), 60.
Although advancements in acceptance and equal treatment of LGBT individuals have been occurring, sexual minority status remains associated with risks to physical and mental well-being. Older LGBT adults are more likely to have experienced mistreatment and discrimination due to living a majority of their lives prior to recent advancements in acceptance and equal treatment... LGBT individuals have higher rates of anxiety, depression, and substance use disorders and also are at increased risk for certain medical conditions like obesity, breast cancer, and human immunodeficiency virus (HIV). Improved education and training of clinicians, coupled with clinical research efforts, holds the promise of improved overall health and life quality for older LGBT adults.
Article Title: Provision of patient-centered transgender care - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Selix, N. W., & Rowniak, S. (2016). Provision of Patient‐Centered Transgender Care. Journal of Midwifery & Women’s Health, 61(6) 744-751.
Transgender individuals have unique health care needs and experience health disparities. There is an increased need for transgender health care services and primary care for this underserved population. However, provision of appropriate health care services for transgender persons requires cultural competency and skill on the part of the health care provider, and providers need specific skills to address the needs of this population.
Websites on Transgender Health
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Article Title: Unbefriended - For full text, click the article title and then click the 'Full Text PDF' button under where the article title appears on the subsequent screen.
Williams, M. A. (2006). Unbefriended. Neurology, 67(11), 2088-2088.
He was brain dead (almost) when I came on the ICU service Monday morning. A man whose name we knew, and whose history and medical records we had, and yet, he had no one with him. “Homeless” is how most people would describe him. “Unbefriended” is how my closest ethicist colleague termed it.... Read how this physician stopped everything, as if compelled, to respect the death of someone who had no one.
Article Title: Palliative care for Muslims and issues after death - For full text, click the article title and then click the PDF link on the left side of the subsequent screen.
Gatrad, R., & Sheikh, A. (2002). Palliative care for Muslims and issues after death. International journal of palliative nursing, 8(12), 594-597.
In this paper we cover issues relating to the immediate handling of the body after death, washing the deceased and reasons for early burial. Muslim views on post-mortems and organ transplantation are explored. In addition to sharing information on practices common among Muslim communities, we also provide practical advice on the day-to-day issues that may arise when caring for a 'recently deceased' Muslim patient and his or her relatives.
Article Title: The cultural expression of death and dying - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Warren, B. J. (2005). The cultural expression of death and dying. The Case Manager, 16(1), 44-47.
Death and dying are universal experiences for people from all cultural groups. This collective experience is intertwined with issues involving mind, body, and spirit in the context of each person's unique culture.
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Article Title: Understanding cultural and linguistic barriers to health literacy - For full text, click the article title. A PDF version is not available.
Singleton, K., & Krause, E. (2009). Understanding cultural and linguistic barriers to health literacy. The Online Journal of Issues in Nursing, 14(3).
Nurses today are providing care, education, and case management to an increasingly diverse patient population that is challenged with a triad of cultural, linguistic, and health literacy barriers. For these patients, culture and language set the context for the acquisition and application of health literacy skills. Yet the nursing literature offers minimal help in integrating cultural and linguistic considerations into nursing efforts to address patient health literacy. Nurses are in an ideal position to facilitate the interconnections between patient culture, language, and health literacy in order to improve health outcomes for culturally diverse patients.
Article Title: Two sides of the coin: patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds - For full text, click the article title and then click the PDF link on the right side of the subsequent screen.
Komaric, N., Bedford, S., & van Driel, M. L. (2012). Two sides of the coin: patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds. BMC health services research, 12(1), 322.
Using focus groups and interviews, this study explores the experiences, attitudes and opinions of immigrants from different cultural and linguistic backgrounds and their health care providers with regard to chronic disease care.
Article Title: Trust, Translation, and HAART, with Commentaries - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Rentmeester, C. A., & DeLancey, D. B. (2008). Trust, Translation, and HAART, with commentaries. Hastings Center Report, 38(6), 13-14.
A case study involving a young Sudanese mother who is HIV positive. She doesn't speak English and her health care providers are faced with a perplexing dilemma relating to providing translation services.
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Article Title: Nature and Impact of Grief Over Patient Loss on Oncologist on Oncologists' Personal and Professional Lives - For full text, click the article title and then click the PDF link on the right side of the subsequent screen.
Granek, L., Tozer, R., Mazzotta, P., Ramjaun, A., & Krzyzanowska, M. (2012). Nature and impact of grief over patient loss on oncologists' personal and professional lives. Archives Of Internal Medicine, 172(12), 964-966. doi:10.1001/archinternmed.2012.1426
This is a qualitative exploration of the nature and impact of grief in oncologists. "We found that for oncologists, patient loss was a unique affective experience that had a smokelike quality. Like smoke, this grief was intangible and invisible. Nonetheless, it was pervasive, sticking to the physicians' clothes when they went home after work and slipping under the doors between patient rooms..."
Article Title: Breast Cancer Education HHS Has implemented Initiatives Aimed at Young Women - For full text, click the article title and then click the PDF link on the left side of subsequent screen.
CROSSE, M. Breast cancer education:HHS Has Implemented Initiatives Aimed at Young Women. GAO Reports. i, Oct. 20, 2016.
A report on the emplementation of the EARLY Act, which directs HHS, including through CDC, HRSA, and NIH, to increase education and support for young women diagnosed with breast cancer by undertaking efforts in four specified areas: (1) prevention research, (2) a public education campaign, (3) support for young women diagnosed with breast cancer, and (4) a health professional education campaign. Discusses grants made by the CDC to increase education, awareness, and provide support programs for young women with breast cancer.
Article Title: When a parent is dying: Helping parents explain death to their children - For full text, click the article title and then click the PDF link in the upper right corner of subsequent screen.
Seccareccia, D., & Warnick, A. (2008). When a parent is dying: Helping parents explain death to their children. Canadian Family Physician, 54(12), 1693–1694.
Dying patients and their spouses often ask their family physicians for guidance, and many times we also feel unprepared. This is not something that is taught in medical school or often discussed in the general medical literature.
Article Title: Doing More: Trends in Breast Cancer Surgery, 2005-2011 - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Lucas, D. J., Sabino, J., Shriver, C. D., Pawlik, T. M., Singh, D. P., & Vertrees, A. E. (2015). Doing more: trends
in breast cancer surgery, 2005 to 2011. The American Surgeon, 81(1), 7480.
An increasing number of women may be choosing mastectomy over breast-conserving surgery for breast cancer as well as undergoing more bilateral resection, immediate reconstruction, and prophylactic operations... Independent predictors of mastectomy included young age, Asian race, invasive cancer (vs carcinoma in situ), bilateral resection, axillary dissection, higher American Society of Anesthesiologists class, and lower body mass index (all P < 0.001).
Web Resources
CDC's Bring Your Brave Website
Website containing educational materials for laypersons on breast cancer in young women, including information about hereditary breast cancer genes. Includes patient stories and social media tools.
CME Activity—Clinical Anthology: Educating Medical Providers About Breast Cancer in Young Women
This activity has been planned and implemented in accordance with the Accreditation Council for Continuing Medical Education and the American Nurses Credentialing Center (ANCC) through the joint providership of Medscape, LLC and CDC’s Division of Cancer Prevention and Control. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians and by the ANCC to provide continuing medical education for nurses.
Medscape, LLC designates this interview-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ and 1.0 ANCC Contact Hour Instructional Design and Rational Credit. Physicians and nurses should claim only the credit commensurate with the extent of their participation in the activity.
Release Date: Jan 18, 2017; Expiration Date: Jan 18, 2018
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Article Title: The Unasked Question - For full text, click the article title and then click the PDF link on the right side of the subsequent screen.
Brown, J. L. (2012, November 14). The Unasked Question. Jama,308(18), 1869-1870. doi:10.1001/jama.2012.14254.
A pediatrician who served as an Army doctor during the Vietnam conflict argues that history taking should always include asking patients about their military background. This question is as important as any other question designed to learn about occupational exposures.
Article Title: Haunted by Their Decisions in War - For full text, click the article title.
Gibbons-Neff, T. (2015, March 6). Haunted by Their Decisions in War. The Washington Post. Retrieved December 5, 2016, from https://www.washingtonpost.com/opinions/haunted-by-their-decisions-in-war/2015/03/06/db1cc404-c129-11e4-9271-610273846239_story.html?utm_term=.df8f48c56f49
A discussion of the concept of moral injury and the author's witness of it in his friend's life after a devastating incident in Afghanistan.
Article Title: Healing a Wounded Sense of Morality - For full text, click the article title.
Puniewska, M. (2015, July 3). Healing a Wounded Sense of Morality. The Atlantic. Retrieved December 5, 2016, from http://www.theatlantic.com/health/archive/2015/07/healing-a-wounded-sense-of-morality/396770/
Many veterans are suffering from a condition similar to, but distinct from, PTSD: moral injury, in which the ethical transgressions of war can leave service members traumatized.
Local Website
Warriers Journey Home - http://warriorsjourneyhome.org/
A local organization dedicated to helping returning veterans adjust to civilian life.
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Article Title: Heroin: Life, Death, and Politics - For full text, click the article title and the PDF version of the article will open in a new window --- Only one concurrent Summa user at a time allowed. If blocked, try the link later.
Jacobson, J. (2014). Heroin: Life, Death, and Politics. American Journal Of Nursing, 114(5), 22-23.
Discusses Good Samaritan laws in the context of drug overdoses, as well as naloxone distribution laws. Tells how one North Carolina nurse became an advocate for such laws after experiencing a personal tragedy.
Article Title: Memorial Day - For full text, click the article title and the PDF version of the article will appear in a new window.
Ross, A. (2016). Memorial Day. Annals Of Emergency Medicine, 67(1), 135-136.
An emergency physician shares his experience of notifying a family that a loved one has died of an overdose.
Article Title: Expanded access to naloxone: options for critical response to the epidemic of opioid overdose mortality - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Kim, D., Irwin, K., & Khoshnood, K. (2009). Expanded access to naloxone: options for critical response to the epidemic of opiod overdose mortality. American Journal Of Public Health, 99(3), 402-407.
Presents advantages and limitations associated with a range of possible naloxone policies and programs. Although this article is over 7 years old, it provides some historical statistics on the escalation of the overdose epidemic and basic background information about naloxone such as safety, effectiveness, and risk-benefit ratio.
Article Title: Safe from harm - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Marriott, S. (2011). Safe from harm. Mental Health Today, 18-20.
Self-harm and borderline personality disorder are often closely linked, and clinicians often make assumptions about these, but what helps and what hinders? This article offers insights for constructive ways for healthcare workers to interact with patients who self-harm.
Article Title: The hateful patient revisited: relevance for 21st century medicine - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Strous, R., Ulman, A., & Kotler, M. (2006). The hateful patient revisited: Relevance for 21st century medicine. European Journal of Internal Medicine, 17(6), 387-393. doi:10.1016
Physicians may encounter a subset of patients who engender strong negative feelings, despair and even downright malice. An understanding of the “hateful patient” can therefore be very informative to the physician. NOTE: This article was also cited as related reading for a previous Summa Schwartz Rounds in September, 2015. In case you missed it then, we are posting it again as a related reading for this month as it is very relevant once again.
Article Title: Raising awarenss of borderline personality disorder and self-injury - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Lamph, G. (2011). Raising awareness of borderline personality disorder and self-injury. Nursing Standard, 26(5), 35-40.
Patients diagnosed with borderline personality disorder are often excluded from services and are highly stigmatised both in mental health services and the wider society. This article aims to increase the awareness of borderline personality disorder and self-injury among non-mental health nurses to assist them to work more effectively with patients who present with these difficulties.
Article Title: Management of borderline personality disorder - For full text, click the article title and then click the green "Download PDF" button on the right side of subsequent screen
Pack, S., Wakeham, S., Beeby, R., Fawkes, E., Yeandle, J., & Gordon, C. (2013, April 16-23). Management of borderline personality disorder. Nursing Times, 109(15), 21-23.
This article gives an overview of personality disorders, with a focus on borderline personality disorder. It also describes some past and current treatment approaches. The authors then describe the treatment approach at their own institution, called "guided formulation."
Article Title: Hold On One Second: Interrupting the Intern Year. - For full text, click on the article title, and then click on "PDF Full Text" on left side of next screen.
George, A. E. (2015). Hold on one second: interrupting the intern year. Medical Education, 49(5), 451-453. doi:10.1111/medu.12746
Aaron George describes a typical scenario from his intern experience and argues that "modern residency is as much about multitasking as it is about medical knowledge, and as much about prioritisation as it is about procedural skill."
Article Title: Fluffing the Pillows - For full text, click on the article title, and then click on "Article as PDF" on right side of next screen.
Beachy, L. (2012). Fluffing the pillows. Nursing, 42(4), 62-63. doi:10.1097/01.NURSE.0000412924.74641.03
A nurse with only 7 months experience learned that she had made an important contribution to the care of a patient that her more experienced colleagues had not been able to provide.
Article Title: Welcome New Nurses to the Wonderful World of Emergency Nursing! - For full text, click on the article title, and then click on "PDF Full Text" on next screen.
Papa, A., & Lefton, C. (2015). Welcome New Nurses to the Wonderful World of Emergency Nursing!. JEN: Journal Of Emergency Nursing, 41(3), 245-248. doi:10.1016/j.jen.2015.01.019
A number of different veteran emergency nurses share their thoughts and advice on how new graduate nurses can survive and thrive in the emergency department.
Article Title: Ethics Roundtable. Assigning an appropriate surrograte. - For full text, click on the article title, and then click on "PDF Full Text" link on next screen.
Baumrucker, S., Stolick, M., Morris, G., VandeKieft, G., Harrington, D., & Sheldon, J. (2007). Ethics roundtable. Assigning an appropriate surrogate. American Journal Of Hospice & Palliative Medicine, 24(5), 422-428.
Professionals from four different disciplines; an ethicist, a lawyer, a physician, a social worker, and a nurse; each address a clinical ethical dilemma involving a decision relating to withdrawing life support from a young patient. There is a conflict between the wishes of an absent legal surrogate, the patient's wife, and the patient's father, who wishes to keep the patient alive despite the a diagnosis of persistant vegetative state.
Article Title: Clinical Ethics Comittees: Organizational Support for Ethical Practice - For full text, click on the article title. For PDF version of article click the green 'Download PDF" button on the right side of next screen
Lachman, V. D. (2010, November/December). Clinical Ethics Committees: Organizational Support for Ethical Practice. Medsurg Nursing, 19(6), 351-353.
Article Title: Epidemiologic Notes and Reports Gasoline Sniffing and Lead Toxicity among Siblings -- Virginia - For full text, click on the article title.
Epidemioligic Notes and Reports Gasoline Sniffing and Lead Toxicity among Siblings -- Virginia. (1985). MMWR: Morbidity and Mortality Weekly Report, 34(29), 449-450, 455.
A case report from the 1980's in which young children were habitually sniffing gasoline for the euphoric effects. These effects were discovered in the process of siphoning gasoline. This habit resulted in lead toxicity for some of the children. Of historical importance, the editorial note states that the US EPA, in 1986 is mandating a 10-fold reduction in lead in gasoline and was "considering a total ban on all lead additives."
AND, RELATED TO THE ABOVE:
Article Title: Lead Poisoning - For full text, click on the article title.
Needleman, H. (2004). LEAD POISONING. Annual Review Of Medicine, 55(1), 209-222.
Understanding of lead toxicity has advanced substantially over the past three decades, and focus has shifted from high-dose effects in clinically symptomatic individuals to the consequences of exposure at lower doses that cause no symptoms, particularly in children and fetuses. See pages 215-6 for a brief discussion of the effects of chronic lead exposure on behavior.
Article Title: Thinking All Wrong about How You Die - For full text, click on the article title, and then click on "PDF Full Text" link on next screen.
Battin, M. P. (2015). Thinking All Wrong about How You Die. Hastings Center Report, 45(4), Insidebackcover. doi:10.1002/hast.473
Article Title: Communication about Serious Illness Care Goals: a Review and Synthesis of Best Practices - For full text, click on the article title. PDF version is available by clicking on the PDF symbol on the extreme right side of next screen.
Bernacki, R. E., & Block, S. D. (2014). Communication about Serious Illness Care Goals: a Review and Synthesis of Best Practices. JAMA Internal Medicine JAMA Intern Med, 174(12), 1994-2003. doi:10.1001/jamainternmed.2014.5271
An understanding of patients' care goals in the context of a serious illness is an essential element of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early discussions about goals of care are associated with better quality of life, reduced use of nonbeneficial medical care near death, enhanced goal-consistent care, positive family outcomes, and reduced costs. Existing evidence does not support the commonly held belief that communication about end-of-life issues increases patient distress.
Article Title: Starting End-of-Life Conversations in Hospital - For full text, click on the article title. PDF version is available by clicking on the green "Download PDF" button on the next screen.
Davis, R. (2015). Starting End-of-Life Conversations in Hospital. Nursing Times, 111(4), 18-21.
Describes the The Conversation Project, aimed at encouraging end-of-life discussions between healthcare providers and patients. "The project team explored the experience of staff based on a ward caring for older people. They found staff sometimes found it difficult to initiate end-of-life conversations and, therefore, to make patient-centred care plans. A development and support programme has improved staff confidence and resulted in more documented planning and discussion about the end of life."
Websites Mentioned During the Rounds:
Death Over Dinner - deathoverdinner.org
The Conversation Project - theconversationproject.org
Five Wishes - www.agingwithdignity.org/five-wishes/
Summa Health System Advance Directives Page - Ohio forms are available here
Article Title: The Duty to Warn and Clinical Ethics: Legal and Ethical Aspects of HIV/AIDS - For full text, click on the article title, and then click on the blue "Download PDF" button on the next screen
Säfken, C., & Frewer, A. (2007). The Duty to Warn and Clinical Ethics: Legal and Ethical Aspects of Confidentiality and HIV/AIDS. HEC Forum,19(4), 313-326.
Article Title: The End of AIDS: HIV as a Chronic Disease - For full text, click on the article title. PDF version is available by clicking on the PDF symbol on the subsequent screen.
Deeks, S. G., Lewin, S. R., & Havlir, D. V. (2013). The end of AIDS: HIV infection as a chronic disease. The Lancet, 382(9903), 1525-1533.
The success of antiretroviral therapy has led some people to now ask whether the end of AIDS is possible. For patients who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life.
Article Title: Microaggression and Its Relevance in Health Care - For full text, click on the article title. For PDF version of article click the green 'Download PDF" button on the right side of next screen
Bleich, M. R. (2015). Microaggression and Its Relevance in Health Care.The Journal of Continuing Education in Nursing,46(11), 487-488.
Article Title: Dealing with Racist Patients - For full text, click on the article title, and then click the PDF link on the right side of subsequent screen
Kimani, P., JD, PhD, Smith, A. K., MD, MPH, Lo, B., MD, & Fernandez, A., MD. (2016). Dealing with Racist Patients. New England Journal of Medicine, 374(8), 708-711.
"A patient’s refusal of care based on the treating physician’s race or ethnic background can raise thorny ethical, legal, and clinical issues — and can be painful, confusing, and scarring for the physicians involved. And we fear that race-based reassignment demands will only increase as the U.S. physician population becomes more racially and ethnically diverse. So we’ve created a framework for considering and addressing such demands.."
Article Title: The Racist Patient - Essay | Additional Commentaries, and Author's Reply - For full text, click on the article title, and then click the PDF link of the left side of the subsequent screen.
Jain, S. H. (2013). The racist patient. Annals Of Internal Medicine, 158(8), 632.
There are two links above. The first is an essay; a compelling account of a doctor's unpleasant encounter with a patient and his own reflections on his internal responses to the event. The second link includes letters that were published in response to the essay followed by a reply to these comments from the author.
Article Title: Bias, Black Lives, and Academic Medicine - For full text, click on the article title, and then click the PDF link on the right side of subsequent screen
Ansell, D. A., & McDonald, E. K. (2015). Bias, Black Lives, and Academic Medicine. New England Journal of Medicine N Engl J Med, 372(12), 1087-1089.
"White Coats for Black Lives" were large demonstrations staged a couple of years ago by medical students to call attention to implicit bias in academic medical centers that result in continued disparities in the recruitment of black physicians and faculty in academic medical centers. These demonstrations also expressed concern for racial disparities in healthcare outcomes in the United States.
Article Title: Transgender Care Moves into the Main Stream - For full text, click on the article title, and then click the PDF link on the right side of subsequent screen
Buchholz, L. (2015). Transgender Care Moves Into the Mainstream. Jama, 314(17), 1785-1787.
Article Title: Civil Rights and Health - Beyond Same Sex Marriage - For full text, click on the article title, and then click the PDF link on the right side of subsequent screen
Landers, S. (2015). Civil Rights and Health — Beyond Same-Sex Marriage. New England Journal of Medicine N Engl J Med,373(12), 1092-1093.
"The idea that the acceptance of same-sex marriage as part of the fundamental right to marriage heralds the end of bad treatment of LGBT people and denial of their rights may be a commonly held notion, but it's most likely overly optimistic, as well as contrary to the evidence on health disparities."
Article Title: The Invisible Elderly: Lesbian, Gay, Bisexual, and Transgender Older Adults - For full text, click on the article title. For PDF version of article click the green 'Download PDF" button on the right side of next screen
Jablonski, R. A., Vance, D. E., & Beattie, E. (2013). The Invisible Elderly: Lesbian, Gay, Bisexual, and Transgender Older Adults.Journal of Gerontological Nursing J Gerontol Nurs, 39(11), 46-52..
More than 2 million older adults identify as lesbian, gay, bisexual, or transgender (LGBT). The purpose of this article is to present an overview of the physical and mental health needs of LGBT older adults to sensitize nurses to the specific needs of this group. Nurses are in a prominent position to create health care environments that will meet the needs of this invisible, and often misunderstood, group of people.
Article Title: Last Chance to Say Goodbye - For full text, click on the article title, and then click the PDF link on the left side of subsequent screen
Ufema, J. (2004). Last chance to say good-bye. Nursing, 34(2), 73-74.
A tragic anecdote about a young man dying of AIDS.
Article Title: Ten strategies to extinguish potentially explosive behavior - For full text, click on the article title, which is a direct link to the full text in PDF format
Leckey, D. (2011). Ten strategies to extinguish potentially explosive behavior. Nursing, 41(8), 55-59.
Article Title: Assaults leave nurses fearful - For full text, click on the article title. For PDF version of article click the green 'Download PDF" button on the right side of next screen
Burns, B. (2014). Assaults leave nurses fearful. Kai Tiaki : Nursing New Zealand, 20(5), 14-7.
Reported assaults on mental health nurses are rising. Behind the statistics are the human faces of nurses coping with the fallout of violence.
Article Title: Sudden death in emergency care: responding to bereaved relatives - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Scott, T. (2013). Sudden death in emergency care: responding to bereaved relatives. Emergency Nurse, 21(8), 36-39.
Many emergency nurses find it difficult to support relatives whose loved ones are being resuscitated or to witness relatives' distress after their family members have died...This article discusses this issue and includes exercises that practitioners can undertake to identify their personal strengths and professional competences when caring for suddenly bereaved relatives.
Article Title: We couldn't come to terms with Hank... until he signed a contract - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Mengel, T. (1992). We couldn't come to terms with Hank... until he signed a contract. Nursing, 22(1), 50-52.
Ever hear of putting an uncontrollable patient in charge of his care? That's what these nurses did when they got him to sign a patient-care agreement. Find out how it worked in this story of bitterness turned to hope.
Article Title: The hateful patient revisited: relevance for 21st century medicine - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Strous, R., Ulman, A., & Kotler, M. (2006). The hateful patient revisited: Relevance for 21st century medicine. European Journal of Internal Medicine, 17(6), 387-393. doi:10.1016
Physicians may encounter a subset of patients who engender strong negative feelings, despair and even downright malice. An understanding of the “hateful patient” can therefore be very informative to the physician.
Article Title: Mean ol' cuss -- or pussycat? - For full text, click the article title and then click the PDF link on the left side of subsequent screen
Seabolt, J. (2006). Mean ol' cuss -- or pussycat?. Nursing, 36(8), 55.
This angry patient was a challenge -- until I realized how much we had in common.
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