Journal Club

“… a serious change is afoot and not just in the meaning of profound loss. Technology’s attendant rational technical practices of classifying, diagnosing, and intervening do not just change the world; they carry the potential to make up new people. So does the cultural sensibility of new generations to use psychoactive substances to manage the […]

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… based on the strength of a present reality. “Engendering hope is important, because it helps the patient to confront the uncertain future.” Kylma et. al. summarize hope engendering interventions … affirmation of patient’s worth, working with the patient, considering the patient in a holistic sense, nurse’s reflection in action. Affirmation of the patient’s worth […]

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… as we have noted before, there is mounting evidence that we need to move away from just “throwing more opioids” at patients with chronic non-malignant pain syndromes … as well as those with multidimensional pain. Some resources … Alberta Hospice Palliative Care Manual (see esp. pp. 12 ff. multidimensional pain) … McBeth’s recent article […]

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Coulehan discusses hope, especially in the context of hospice and palliative care… “Studies of terminally ill patients have demonstrated clusters of personal and situational factors associated with enhancement or suppression of hope at the end of life. Enhancing factors included interpersonal connectedness, attainable goals, spiritual beliefs and practices, personal attributes of determination, courage, and serenity, […]

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“The ability to interact effectively with  angry  patients is a  skill  that is often  learned with  experience and  is extremely useful in both transforming the patients’ reaction into a more creative emotion and  in developing a therapeutic relationship … Almost always, anger will resolve if the patient is given time, respect, clear information and consistency […]

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… the third section of Billings’ family meetings in the ICU setting. Do not feel you need to identify every management option. We do not have a responsibility to offer treatment options that will not benefit the patient. Asking, ‘‘What do you want us to do?’’ or ‘‘Do you want us to do everything?’’ requires the family to […]

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… the second part of Billings’ article on family meetings in the ICU setting. “A key point: the clinical team ideally will make clear, strong recommendation to the family, based on the patient’s wishes, rather than asking family members what they want to have done.”

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… perfect practice makes perfect … “Élite performers, researchers say, must engage in “deliberate practice”—sustained, mindful efforts to develop the full range of abilities that success requires. You have to work at what you’re not good at. In theory, people can do this themselves. But most people do not know where to start or how […]

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… when their loved one is seriously ill … assure their loved one is receiving high quality care provide appropriate information adequate time to share perspectives and concerns accurate information about prognosis empathic communication and support trust anticipatory grief and bereavement   from Billing’s End of Life Family Meeting Part I: Indications, Outcomes, and Family Needs […]

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… don’t push (“righting reflex”) but reflect … Pollack et. al. discuss how to talk with patients and families when they are resistant to discussing the future or are ambivalent and unable to make a decision. Criteria to know if we have been successful … Letting patients talk as much as clinicians; Keeping question-asking to […]

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